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Slippery dopamine-fluoropolymer hybrid surface for improving biliary stent longevity

Wed, 01 Jul 2026 00:00:00 GMT

Title: Slippery dopamine-fluoropolymer hybrid surface for improving biliary stent longevity Authors: Kim, Tae Young; Lee, Won-Jong; Lee, Yurim; Kim, Seo Jung; Min, Sungjin; Chung, Seyong; Kim, Soo A.; Yook, Keun-Young; Moon, Chang-Hwan; Lee, Yeontaek; Park, Kijun; Kim, Dae-Hyun; Seo, Jungmok Abstract: Biliary obstruction leads to bile retention and triggers a cascade of pathological events. Bile accumulation induces cholestasis and inflammation, progressing to hepatocellular injury, fibrosis, and ultimately liver failure. To restore bile flow, biliary stents are a necessary option due to their immediate patency. However, their high susceptibility to foreign body reaction (FBR) associated fibrosis, biofilm formation, and biliary sludge accumulation leads to frequent occlusion. To address this limitation, we developed the Enhanced Longevity by antifouling Functional coating for Stent (ELFS), a lubricant-infused coating that prevents stent occlusion. ELFS can be readily fabricated via a simple dip-coating solution process and employ a polydopamine (PDA) adhesion layer. Intravital imaging in mice confirmed that ELFS suppressed the FBR by blocking early neutrophil adhesion, which in turn prevented downstream immune-fibrotic cascades. At 3 h, neutrophil recruitment in the non-coated group was >20-fold higher than in ELFS-coated groups. Additionally, ELFS-coated stents remained free of biofilm for over six months in mice and maintained full open for two months in a rabbit common bile duct model. In contrast, non-coated stents resulted in complete occlusion, bile duct dilation (over 4 times), hepatomegaly (over 2 times), and fibrosis.

Web-based discharge education program for caregivers of children with epilepsy: A feasibility study

Fri, 01 May 2026 00:00:00 GMT

Title: Web-based discharge education program for caregivers of children with epilepsy: A feasibility study Authors: Lee, Hyunjie; Oh, Eui Geum; Lee, Seung Eun; Kang, Hoon-Chul; Shin, Hae-kyung; Cha, Yerin; Choi, Eun Kyoung Abstract: Purpose: This study aimed to develop and evaluate the feasibility of a theory-driven, web-based discharge education program designed to enhance self-management among caregivers of children with epilepsy. Methods: Following the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model, educational needs were assessed through an integrative literature review and focus group interviews with caregivers and pediatric nurses. The program was structured using the Include, Discuss, Educate, Assess, and Listen (IDEAL) discharge planning framework, and individual and family self-management theory. Results: The key features included self-assessment tools, pre-discharge questions, multimedia materials, health diaries, and Q&A boards. Content validity was reviewed by experts, usability tested with caregivers and professionals, and clinical feasibility examined using a one-group pretest-posttest design involving 13 caregivers. Participants reported high satisfaction with the clarity and accessibility of the content, with strongest engagement in the self-assessment and pre-discharge sections. Although changes in discharge readiness and selfmanagement scores were not statistically significant, moderate-to-large effect sizes suggested an increasing trend in practical improvement. Caregivers also reported improved confidence, medications awareness, and follow-up adherence. Feedback supported mobile-based delivery and highlighted the need for interactive and personalized features. Conclusions: The program is a feasible and accepted intervention that incorporates self-assessment into discharge education and leverages web-based delivery to support family centered care. Practice implications: The program addresses existing gaps in pediatric epilepsy education and shows potential for broader implementation. Integrating self-assessment and digital platforms into discharge education may enhance caregivers' preparedness and support sustainable self-management. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cross-Population Validation of the Pediatric CKD Risk-Prediction Tool

Fri, 01 May 2026 00:00:00 GMT

Title: Cross-Population Validation of the Pediatric CKD Risk-Prediction Tool Authors: Park, Peong Gang; Kim, Jayoun; Choi, Naye; Kim, Ji Hyun; Lim, Seon Hee; Lee, Joo Hoon; Park, Min Ji; Baek, Hee Sun; Cho, Min Hyun; Lee, Keum Hwa; Il Shin, Jae; Han, Kyoung Hee; Kim, Jeong Yeon; Song, Ji Yeon; Yang, Eun Mi; Kim, Seong Heon; Ahn, Yo Han; Kang, Hee Gyung; Park, Eujin Abstract: Introduction: This study aimed to externally validate the performance of the kidney replacement therapy (KRT) risk prediction calculator for chronic kidney disease (CKD) in children in an ethnically distinct East Asian population. Methods: We externally validated the KRT risk prediction calculator for CKD in children using data from the KoreaN Cohort Study on Outcomes in Pediatric CKD (KNOW-Ped CKD) cohort. Six parametric survival models from the generalized gamma family were tested, stratified into 2 groups as follows: change in glomerular filtration rate (GFR)-based (group 1) and cross-sectional (group 2). Missing data (# 7.9%) were addressed via multiple imputations using chained equations. Outcomes were timed to KRT initiation. The model performance was evaluated based on goodness-of-fit, discrimination ability, calibration, and predictive ability. Results: Overall, 533 children were included in the validation cohort. The median age and baseline estimated GFR (eGFR) were 10.8 years (interquartile range [IQR]: 5.3-14.5) and 57.6 ml/min per 1.73 m 2 (IQR: 34.8-81.4), respectively. Over a median follow-up of 4.8 years (IQR: 2.0-8.9), KRT was initiated in 171 participants (32.1%). Models in group 1 (n = 433) and 2 (n = 533) demonstrated excellent discrimination ability (C-statistic: 0.911-0.972). The calibration slopes exceeded 0.9 across all models, though the Greenwood-Nam-D'Agostino goodness-of-fit test indicated a miscalibration (P < 0.001). Enriched models incorporating the eGFR slope showed the closest alignment with the observed risks. Conclusion: These findings underscore the potential utility of the calculator in improving prognostication and clinical decision-making in pediatric CKD.

Systematic Review of Efficacy and Safety of Avacopan in Real-World Clinical Practice

Wed, 01 Apr 2026 00:00:00 GMT

Title: Systematic Review of Efficacy and Safety of Avacopan in Real-World Clinical Practice Authors: Berke, Ilay; Keller, Felix; Untersulzner, Clemens; Shin, Jae; Park, Peong Gang; Oh, Sarah Soyeon; Callemeyn, Jasper; Kronbichler, Andreas Abstract: Introduction: Avacopan, a complement 5a receptor (C5aR) antagonist, is a therapeutic option for patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), and is used as a steroid-sparing agent. The efficacy and safety of avacopan were established in the pivotal phase III ADVOCATE trial. However, there remains a paucity of real-world evidence to confirm these findings across diverse clinical settings and populations. Methods: We conducted a systematic review of 16 real-world studies evaluating the clinical outcomes of avacopan in patients with AAV. Using a meta-analytic approach, we compared efficacy and safety outcomes reported in these studies with those of the main trial. Key end points included clinical remission and incidence of adverse events. Results: The aggregated real-world data demonstrated that the time from diagnosis of AAV or relapse and initiation of avacopan was 24 days (range: 6-54 days). The clinical remission rates at 6 months as assessed in 215 patients were 89% (95% confidence interval [CI]: 0.84-0.93), whereas the rates of serious infection were 14% (95% CI: 0.10-0.18). We observed a heterogeneity between populations when hepatotoxicity was assessed in real-world cohorts, with this signal being particularly pronounced in Japanese populations. Conclusion: Avacopan has been found to demonstrate both safety and high efficacy in the treatment of AAV in real-world settings, with remission rates exceeding and serious infection rates comparable to those observed in clinical trial data. However, the higher incidence of hepatotoxicity in certain populations underscores the need for careful monitoring and pharmacovigilance studies to clarify risk factors and guide patient selection.