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Recently, a method of fabricating an esthetic anterior fixed prosthesis by integrating data such as three-dimensional facial scan and jaw motion to form a virtual patient with dynamic occlusion has been introduced. This enables smooth communication with patients during the diagnosis process, improves the predictability of esthetic prosthetic treatment, and lowers the possibility of occlusal adjustment. In this case report, a virtual patient with dynamic occlusion was created in which the results of the treatment were simulated, and esthetic maxillary anterior fixed prosthesis was fabricated. With the aid of the virtual patient, the final restorations were satisfactory both in terms of esthetic and function.
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Background@#Epigallocatechin gallate (EGCG) is a flavonoid compound commonly found in green tea. It exhibits antioxidant, anti-inflammatory, and neuroprotective effects in cerebral ischemia. Protein phosphatase 2 A (PP2A) is an important serine/threonine phosphatase enzyme involved in various cellular activities. PP2A subunit B is present abundantly in the brain and plays an important role in the nervous system. We investigated the effect of EGCG on the expression level of PP2A subunit B in cerebral ischemia caused by middle cerebral artery occlusion (MCAO). EGCG (50 mg/kg) or vehicle was injected into the peritoneal cavity prior to MCAO surgery. Neurological behavior tests were performed 24 h after MCAO, and right cerebral cortex tissue was collected. Cerebral ischemia caused serious neurological abnormalities, which were alleviated by EGCG administration. We screened the expression of PP2A subunits containing A, B, and C using reverse-transcription PCR. We confirmed that PP2A subunit B exhibited significant changes in MCAO animals compared to subunits A and C. We continuously examined the expression of PP2A subunit B protein in MCAO animals using Western blot analysis. @*Results@#EGCG alleviated the reduction of PP2A subunit B protein by MCAO damage. In addition, immunohistochemistry demonstrated a decrease in the number of PP2A subunit B-positive cells in the cerebral cortex, and EGCG attenuated this decrease. Maintenance of PP2A subunit B is important for normal brain function. @*Conclusion@#Therefore, our findings suggest that EGCG exerts neuroprotective effects against cerebral ischemia through modulation of PP2A subunit B expression.
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Background@#Cerebral ischemia is a serious neurological disorder that can lead to high morbidity and mortality. Chlorogenic acid is a polyphenol compound with antioxidant that can regulate proteins in cerebral ischemia. Middle cerebral artery occlusion (MCAO) surgery was performed to induce ischemic brain injury and was maintained for 24 h. Chlorogenic acid (30 mg/kg) or vehicle was administrated into the peritoneal cavity 2 h after MCAO surgery. The cerebral cortical tissues were collected for further study and a proteomic approach was performed to identify the proteins changed by chlorogenic acid in the MCAO animals. @*Results@#We found that chlorogenic acid alleviated in changes in adenosylhomocysteinase, glycerol-3-phosphate dehydrogenase, eukaryotic translation initiation factor 4A-II, apolipoprotein A-I, and mu-crystallin. These proteins were reduced in MCAO animals with vehicle, and these reductions were attenuated by chlorogenic acid treatment. The mitigation of this reduction by chlorogenic acid was confirmed by the reverse transcription PCR technique. These proteins are associated with energy metabolism, protein synthesis, inflammation, and physiological metabolism. They are involved in the neuroprotective effect of chlorogenic acid. These results showed that chlorogenic acid alleviates the neurological disorders caused by MCAO and regulates the expression of proteins involved in neuroprotection. @*Conclusions@#Therefore, our findings provide evidence that chlorogenic acid plays a neuroprotective role in stroke animal models by controlling specific proteins.
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Stroke is a major cause of death and long-term disability. Chlorogenic acid is a phenolic compound with a potent neuroprotective effect. γ-enolase is a phosphopyruvate hydratase found in mature neurons and plays an important role in the neuronal survival. This study investigated whether chlorogenic acid regulates the expression of γ-enolase during cerebral ischemia. Middle cerebral artery occlusion (MCAO) was performed to indcue cerebral ischemia. Adult male rats were used and chlorogenic acid (30 mg/kg) or phosphate buffered saline (PBS) was injected intraperitoneally 2 hours after MCAO surgery. Cerebral cortical tissues were collected 24 hours after MCAO surgery. Our proteomic approach identified the reduction of γ-enolase caused by MCAO damage and the mitigation of this reduction by chlorogenic acid treatment. Results of reverse transcription-polymerase chain reaction and Western blot analyses showed decrease in γ-enolase expression in PBS-treated MCAO group. However, chlorogenic acid treatment attenuated this decrease. Results of immunofluorescence staining showed the change of γ-enolase by chlorogenic acid treatment. These results demonstrated that chlorogenic acid regulates the γ-enolase expression during MCAO-induced ischemia. Therefore, we suggest that chlorogenic acid mediates the neuroprotective function by regulating the γ-enolase expression in cerebral ischemia and may be used as a therapeutic agent for brain diseases including stroke.
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Background@#The forehead is a region connected to the scalp and is accompanied by various structures. In some tumors, the pattern of development may differ from that of other anatomical sites. When a noninflammatory skin-colored tumor develops on the forehead, it is difficult to diagnose accurately. @*Objective@#This study aimed to identify the epidemiologic data and clinical features of noninflammatory skin-colored tumors of the forehead. @*Methods@#We retrospectively reviewed the medical records of 200 patients with noninflammatory, skin-colored tumors diagnosed after skin biopsy over a period of 11 years. We evaluated tumor prevalence, clinical features, and differences according to sex and age. If the tumor was large and deeply located, a radiologic study was performed. @*Results@#Of the 12 different histopathologic results, lipoma (52.0%) was the most frequent, followed by epidermal cyst (17.0%), osteoma (13.5%), steatocystoma (6.0%), and pilomatricoma (3.5%). Statistical analysis showed that females were dominant in the osteoma group. For an accurate diagnosis, 25 of the 52 patients who underwent computed tomography were diagnosed with lipoma, and 19 (76.0%) of them were identified as deep-seated lipoma. @*Conclusion@#The most common tumor among noninflammatory, skin-colored tumors of the forehead was lipoma.When they occur on the forehead, the proportion of deep-seated lipomas is higher than that at other sites. In the case of a solid and fixed tumor, a deep-seated lipoma should be considered. Computed tomography should be performed in addition to ultrasonography because the sensitivity of ultrasonography for the diagnosis of deep-seated lipoma is unsatisfactory.
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Objective@#This study verifies the practicality of the delta neutrophil index to lymphocyte ratio for the prognostic evaluation of sepsis patients. @*Methods@#Records of 2,233 patients diagnosed with sepsis were reviewed; 1,042 patients were included in the final analysis. Receiver operating characteristic (ROC) curve studies were used to calculate the area under the curve (AUC) to determine the neutrophil-to-lymphocyte ratio (NLR) and the delta neutrophil-to-lymphocyte ratio (Delta-NLR). To adjust for skewed distributions, the NLR and Delta-NLR were analyzed after natural logarithm transformations. Multivariate logistic regression was applied to determine potential predictors for mortality. @*Results@#To predict 30-day mortality, AUCs were performed using the values of days 0, 1, and 2 (0.604, P<0.0001; 0.648, P<0.0001; and 0.684, P<0.0001, respectively). The NLR results were 0.504 (P=0.8624), 0.553 (P=0.0191), and 0.598 (P<0.0001), respectively. The AUC increased significantly when the Delta-NLR at day 0 was combined with age, hemoglobin levels, and lactate levels. Further subgroup analysis was performed by dividing patients into an upper respiratory infection (URI) group, a gastrointestinal tract infection (GI) (including hepatobiliary infection) group, and a urinary tract infection (UTI) group. The predictive ability of the GI group was determined to be much higher than the other two groups. @*Conclusion@#Increase in the Delta-NLR of sepsis patients was found to be an independent predictor of mortality within 30 days.
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Considerable evidence has been published since the 2020 Korean Cardiopulmonary Resuscitation Guidelines were reported. The International Liaison Committee on Resuscitation (ILCOR) also publishes the Consensus on CPR and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) summary annually. This review provides expert opinions by reviewing the recent evidence on CPR and ILCOR treatment recommendations. The authors reviewed the CoSTR summary published by ILCOR in 2021 and 2022. PICO (population, intervention, comparator, outcome) questions for each topic were reviewed using a systemic or scoping review methodology. Two experts were appointed for each question and reviewed the topic independently. Topics suggested by the reviewers for revision or additional description of the guidelines were discussed at a consensus conference. Forty-three questions were reviewed, including 15 on basic life support, seven on advanced life support, two on pediatric life support, 11 on neonatal life support, six on education and teams, one on first aid, and one related to coronavirus disease 2019 (COVID-19). Finally, the current Korean CPR Guideline was maintained for 28 questions, and expert opinions were suggested for 15 questions.
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Objectives@#This study identifies the socioeconomic characteristics and attitudes toward suicide (ATTS) of gatekeepers participating in a suicide prevention project in Gyeongsangbuk-do. Through this study we hope to increase the understanding required to prevent suicide in the community. @*Methods@#We conducted a survey from October 11 to November 4, 2022, with 1,284 individuals from private organizations who participated in the suicide prevention project between September 23 and November 30, 2022. The survey established demographic characteristics, experience in participating in suicide prevention projects, awareness and need for suicide prevention and mental health services, and ATTS. The study conducted cross-analysis and chi-square tests to identify differences in responses according to demographics. An independent sample t-test, one-way analysis of variance, and Scheffe’s post hoc test were performed to analyze the comparisons between each measurement factor. SPSS 21.0 was used to process data and the level of statistical significance was set to p<0.05. @*Results@#The gatekeepers’ ATTS were moderate, with an average of 3.11 out of 5. Specifically, preventability obtained the highest score (4.07), followed by preparedness to prevent (3.96), incomprehensibility (3.74), and noncommunication (3.34). Conversely, resignation obtained the lowest score (2.05), followed by tabooing (2.32) and relation-caused (2.51). The scores for preventability and preparedness to prevent increased with sustained participation in the suicide prevention program, while those for suicidal process decreased. @*Conclusions@#Gatekeepers’ ATTS may improve as a result of participation in the suicide prevention project, with better results with continued participation. Thus, actively recruiting more gatekeepers and keeping them engaged in the program may help prevent suicide.
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Objectives@#The purpose of this study is to analyze the prevalence and factors of depression among the elderly population, a significant issue in Korea’s aging society. We aim to provide basic indicators for improving mental health and quality of life. @*Methods@#From February to December 2021, a study was conducted on a population of 19,158 elderly individuals aged 65 and above residing in Gyeongsangbuk-do province. The severity of depression was evaluated using the Korean version of the Patient Health Questionnaire (PHQ)-9. In addition, demographic information was collected to analyze factors that may influence depression. @*Results@#In the PHQ-9 screening, the average score was 3.65. The results showed that 13,705 individuals (71.5%) were in the normal group with scores ranging from 0 to 4, 3,683 individuals (19.2%) were in the mild group with scores ranging from 5 to 9, 1,575 individuals (8.2%) were in the moderate group with scores ranging from 10 to 19, and 195 individuals (1.0%) were in the severe group with scores of 20 or higher. It was found that place of residence, education level, type of housing, top two difficulties in daily life, subjective economic status, desired services, subjective mental health, past and current history of mental health treatment, and medication for physical illness had statistically significant effects on depression. @*Conclusions@#Various factors were found to have a significant impact on depression among the elderly population in Gyeongsangbuk-do. Proactive prevention and treatment tailored to the population characteristics of the region may be necessary.
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Background@#Nirmatrelvir-ritonavir is highly effective in preventing severe coronavirus disease 2019 (COVID-19) in high-risk patients with mild-to-moderate severity. However, real-world performance data are limited, and the drug is not so acceptable to the COVID-19 patients at high risk who need it in Korea. @*Methods@#To evaluate the effectiveness of nirmatrelvir-ritonavir, we conducted a propensity score-matched retrospective cohort study on patients with mild-to-moderate COVID-19 at high risk for a severe disease who were hospitalized at four hospitals in South Korea from February 2022 to April 2022. A total of 236 patients in the treatment group (administered nirmatrelvir-ritonavir) and 236 in the matched control group (supportive care only) were analyzed for the primary outcome, i.e., the time to oxygen support-free survival. The secondary outcome was a composite result of disease progression. The reason for not prescribing nirmatrelvir-ritonavir to the indicated patients was also investigated. @*Results@#The treatment group showed significantly longer oxygen support-free survival than the matched control group (adjusted hazard ratio [aHR], 0.07; 95% confidence interval [CI], 0.01–0.31; P < 0.001). Multivariate Cox regression analysis showed that age (aHR, 1.03; 95% CI, 1.00–1.07), National Early Warning Score-2 at admission (aHR, 1.36; 95% CI, 1.08–1.71), nirmatrelvir-ritonavir treatment, female sex (aHR, 0.37; 95% CI, 0.15–0.88), and time from symptom onset to admission (aHR, 0.67; 95% CI, 0.48–0.95) were significantly associated with oxygen therapy. However, none of the factors were related to the composite outcome. In the unmatched control group, 19.9% of 376 patients had documented explanations for nirmatrelvir-ritonavir non-prescription, and 44.0% of these were due to contraindication criteria. In the treatment group, 10.9% of patients discontinued the medication primarily because of adverse events (71.4%), with gastrointestinal symptoms being the most common (50.0%). @*Conclusion@#Nirmatrelvir-ritonavir treatment significantly reduced oxygen therapy requirements in high-risk patients with COVID-19 during the omicron variant surge in South Korea. Physicians are encouraged to consider the active use of nirmatrelvir-ritonavir and to be watchful for gastrointestinal symptoms during medication.
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Neural processing of tactile information in the brain has been relatively less unveiled compared to other senses, such as visual and auditory information. This is partly due to difficulties in creating tactile stimuli, a wide distribution of tactile receptors over the whole body, the lack of rich understanding of tactile perception, and tight coupling of tactile sensation with action. Nonetheless, it is important to understand how the central nervous system processes tactile information in order to develop clinical solutions for impairment of somatosensory systems, create artificial tactile systems for robots, and advance the assistive technology based on perception-action coupling for the elderly. In this review, we revisit recent investigations of neural processing of tactile information in the human brain using neuroimaging. In particular, this review focuses on cutaneous innocuous tactile information.
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To develop a biomimetic artificial tactile sensing system capable of detecting sustained mechanical touch, we propose a novel biological neuron model (BNM) for slowly adapting type I (SA-I) afferent neurons. The proposed BNM is designed by modifying the Izhikevich model to incorporate long-term spike frequency adaptation. Adjusting the parameters renders the Izhikevich model describing various neuronal firing patterns. We also search for optimal parameter values for the proposed BNM to describe firing patterns of biological SA-I afferent neurons in response to sustained pressure longer than 1-second. We obtain the firing data of SA-I afferent neurons for six different mechanical pressure ranging from 0.1 mN to 300 mN from the ex-vivo experiment on SA-I afferent neurons in rodents. Upon finding the optimal parameters, we generate spike trains using the proposed BNM and compare the resulting spike trains to those of biological SA-I afferent neurons using the spike distance metrics. We verify that the proposed BNM can generate spike trains showing long-term adaptation, which is not achievable by other conventional models. Our new model may offer an essential function to artificial tactile sensing technology to perceive sustained mechanical touch.
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Decision-making is a complex process that involves the integration and interpretation of sensory information to guide actions. The rodent motor cortex, which is generally involved in motor planning and execution, also plays a critical role in decision-making processes. In perceptual delayedresponse tasks, the rodent motor cortex can represent sensory cues, as well as the decision of where to move. However, it remains unclear whether erroneous decisions arise from incorrect encoding of sensory information or improper utilization of the collected sensory information in the motor cortex. In this study, we analyzed the rodent anterior lateral motor cortex (ALM) while the mice performed perceptual delayed-response tasks. We divided population activities into sensory and choice signals to separately examine the encoding and utilization of sensory information.We found that the encoding of sensory information in the error trials was similar to that in the hit trials, whereas choice signals evolved differently between the error and hit trials. In error trials, choice signals displayed an offset in the opposite direction of instructed licking even before stimulus presentation, and this tendency gradually increased after stimulus onset, leading to incorrect licking. These findings suggest that decision errors are caused by biases in choice-related activities rather than by incorrect sensory encoding. Our study elaborates on the understanding of decisionmaking processes by providing neural substrates for erroneous decisions.
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Poly(ADP-ribose) polymerase inhibitors have been shown dramatic responses in patients with BRCAness. However, clinical studies have been limited to breast cancer patients with germline mutations. Here, we describe a patient with metastatic breast cancer who had a rare BRCA1 somatic mutation (BRCA1 c.4336G>T (p.E1446*)) detected by cell-free DNA analysis after failing standard therapies. This tier III variant of unknown significance was predicted to be a pathogenic variant in our assessment, leading us to consider off-label treatment with olaparib. The patient responded well to olaparib for several months, with a decrease in allele frequency of this BRCA1 somatic mutation in cell-free DNA. Olaparib resistance subsequently developed with an increase in the allele frequency and new BRCA1 reversion mutations. To our knowledge, this is the first report confirming BRCA1 c.4336G>T (p.E1446*) as a mutation sensitive to olaparib in breast cancer and describing the dynamic changes in the associated mutations using liquid biopsy.
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Purpose@#Most bee sting injuries are benign, although sometimes they can result in life threatening outcomes, such as anaphylaxis and death. The purpose of this study was to investigate the epidemiologic status of bee sting injuries in Korea and to identify risk factors associated with severe systemic reactions (SSRs). @*Materials and Methods@#Cases were extracted from a multicenter retrospective registry for patients who had visited emergency departments (EDs) for bee sting injuries. SSRs were defined as hypotension or altered mental status upon ED arrival, hospitalization, or death. Patient demographics and injury characteristics were compared between SSR and non-SSR groups. Logistic regression was performed to identify risk factors for bee sting-associated SSRs, and the characteristics of fatality cases were summarized. @*Results@#Among the 9673 patients with bee sting injuries, 537 had an SSR and 38 died. The most frequent injury sites included the hands and head/face. Logistic regression analysis revealed that the occurrence of SSRs was associated with male sex [odds ratio (95% confidence interval); 1.634 (1.133–2.357)] and age [1.030 (1.020–1.041)]. Additionally, the risk of SSRs from trunk and head/ face stings was high [2.858 (1.405–5.815) and 2.123 (1.333–3.382), respectively]. Bee venom acupuncture [3.685 (1.408–9.641)] and stings in the winter [4.573 (1.420–14.723)] were factors that increased the risk of SSRs. @*Conclusion@#Our findings emphasize the need for implementing safety policies and education on bee sting-related incidents to protect high-risk groups.
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Purpose@#The purpose of this study was to estimate the medical expenditures for poisoning patients in Korea using data from National Health Insurance and the Korea Health Panel Survey. @*Methods@#The operational definition of poisoning was the presence of Korean Standard Classification of Diseases codes from T36 to T65. The number of poisoning patients, the amount of legal copayments, and benefit and non-benefit costs were extracted from both databases. The frequency of emergency, inpatient, and outpatient treatment utilization by poisoning patients was determined, and medical expenses were calculated. Linear regression analyses were performed to investigate factors affecting the medical expenses of poisoning patients. @*Results@#The number of poisoning patients increased from 97,965 in 2011 to 147,984 persons in 2020. Medical expenses also increased by 74% from Korean won (KRW) 30.1 billion to KRW 52.3 billion, and benefit costs also increased by 79%. The average outpatient cost per person was KRW 67,660, and the inpatient cost was KRW 1,485,103. The average non-benefit medical expenses were KRW 80,298, accounting for about 16.2% of the total expenses. Multivariable analysis showed that the total expenditure was associated with economic status and disabilities. @*Conclusion@#The average medical expenditure per poisoning patient was KRW 534,302 in 2020, and poisoning-related costs gradually increased during the study period. Further research on the economic burden of poisoning should include indirect costs and reflect disease-adjusted life years.
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This study aimed to investigate the prevalence of carbon monoxide (CO) poisoning and the provision of hyperbaric oxygen therapy (HBOT) in South Korea. We used data from the Korea Health Insurance Review and Assessment service. In total, 44,361 patients with CO poisoning were identified across 10 years (2010–2019). The prevalence of CO poisoning was found to be 8.64/10,000 people, with a gradual annual increment. The highest prevalence was 11.01/10,000 individuals, among those aged 30–39 years. In 2010, HBOT was claimed from 15 hospitals, and increased to 30 hospitals in 2019. A total of 4,473 patients received HBOT in 10 years and 2,684 (60%) were treated for more than 2 hours. This study suggested that the prevalence of both CO poisoning and HBOT in Korea gradually increased over the past 10 years, and disparities in prevalence were observed by region.
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Background@#and Purpose To determine the imaging characteristics and cutoff value of18F-florapronol (FC119S) quantitative analysis for detecting β-amyloid positivity and Al- zheimer’s disease (AD), we compared the findings of FC119S and 18F-florbetaben (FBB) positron-emission tomography (PET) in patients with cognitive impairment. @*Methods@#We prospectively enrolled 35 patients with cognitive impairment who underwent FBB-PET, FC119S-PET, and brain magnetic resonance imaging. We measured global and vertex-wise standardized uptake value ratios (SUVRs) using a surface-based method with the cerebellar gray matter as reference. Optimal global FC119S SUVR cutoffs were determined using receiver operating characteristic curves for β-amyloid positivity based on the global FBB SUVR of 1.478 and presence of AD, respectively. We evaluated the global and vertex-wise SUVR correlations between the two tracers. In addition, we performed correlation analysis for global or vertex-wise SUVR of each tracer with the vertex-wise cortical thicknesses. @*Results@#The optimal global FC119S SUVR cutoff value was 1.385 both for detecting β-amyloid positivity and for detecting AD. Based on the global SUVR cutoff value of each tracer, 32 (91.4%) patients had concordant β-amyloid positivity. The SUVRs of FC119S and FBB had strong global (r=0.72) and vertex-wise (r>0.7) correlations in the overall cortices, except for the parietal and temporal cortices (0.4
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Background@#Diabetes mellitus (DM) is one of the most common endocrine diseases, and the relationship between diabetes and skin diseases is well-known and its mechanisms have been studied. @*Objective@#This study aimed to examine the association between DM and skin diseases. @*Methods@#We used the medical record database provided by the National Health Insurance Service. We constructed a cohort with 1,197,225 patients diagnosed with type 2 DM from 2011 to 2015. We analyzed 3,992,368 medical records of patients with DM who visited the hospital from January 1, 2009 to December 13, 2018 with skin and subcutaneous tissue diseases (ICD-10 code, L00-L99). After that, we compared the changes in skin and subcutaneous tissue diseases before and after the diagnosis of type 2 DM. @*Results@#The number of patients with skin diseases, after the diagnosis of type 2 DM was 1,629,756 (50.6%). The frequency of skin diseases increased after the diagnosis of type 2 DM compared to that before the diagnosis. Particularly, infectious diseases (＋29.03%,p＜0.001), vesiculobullous diseases (＋33.13%, p＜0.001) and ulcerrelated diseases (pressure sores [＋530.18%], and lower extremity ulcers [＋321.56%], p＜0.001) increased sharply whereas dermatitis and eczematous diseases (−9.96%, p＜0.001) and urticaria (−12.99%, p＜0.001) decreased. @*Conclusion@#Skin diseases increased following the diagnosis of diabetes, and there were changes in the pattern of skin diseases before and after the diagnosis of diabetes.
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Subjective cognitive complaints (SCCs) refer to self-perceived cognitive decline and are related to objective cognitive decline. SCCs in cognitively normal individuals are considered a preclinical sign of subsequent cognitive impairment due to Alzheimer’s disease, and SCCs in cognitively normal patients with Parkinson’s disease (PD) are also gaining attention. The aim of this review was to provide an overview of the current research on SCCs in cognitively normal patients with PD. A systematic search found a lack of consistency in the methodologies used to define and measure SCCs. Although the association between SCCs and objective cognitive performance in cognitively normal patients with PD is controversial, SCCs appear to be predictive of subsequent cognitive decline. These findings support the clinical value of SCCs in cognitively normal status in PD; however, further convincing evidence from biomarker studies is needed to provide a pathophysiological basis for these findings. Additionally, a consensus on the definition and assessment of SCCs is needed for further investigations.