Incidence and Risk Factors of Recurrent Anterior Uveitis in Initial Acute-Onset Vogt-Koyanagi-Harada Disease

Purpose@#We report the estimated incidence of, and risk factors for, recurrent anterior uveitis in patients with initial acute-onset Vogt-Koyanagi-Harada (VKH) disease using survival analyses. @*Methods@#Patients who were diagnosed with initial acute-onset VKH disease during 2003–2022 at two university hospitals were included. Recurrent anterior uveitis was defined as the first occurrence of the granulomatous anterior uveitis with anterior chamber cells and flare of 2+ or more by the Standardization of Uveitis Nomenclature (SUN) Working Group grading scheme, after the disappearance of conspicuous uveitis and serous retinal detachment for at least 3 months, regardless of systemic or local treatment. The univariate log-rank test and multivariate Cox regression analyses were performed, including patients’ demographic characteristics, underlying diseases, presence of prodromal symptoms, duration of visual symptoms, visual acuity, slit-lamp and fundus findings, and height of serous retinal detachment. The treatment method and response to treatment were also included. @*Results@#The estimated incidence was 39.3% at 10 years. Fifteen of 55 patients (27.3%) had recurrent anterior uveitis during the mean follow-up of 4.5 years. The presence of focal posterior synechiae at the diagnosis increased the risk of recurrent anterior uveitis 6.97-fold compared to the absence of synechiae (95% confidence interval [CI], 2.20–22.11; p < 0.001). Use of systemic high-dose steroid therapy more than 7 days after the development of visual symptoms resulted in a hazard ratio of 4.55 (95% CI, 1.27–16.40; p = 0.020). @*Conclusions@#This study reports the estimated incidence and risk factors of recurrent anterior uveitis in VKH disease from survival analyses. However, because of the retrospective nature of this study, it is hard to confirm the consistency of the medical records regarding risk factors, thus, the presence of focal posterior synechiae can be inconclusive as a risk factor. Further studies are warranted.

Kalkitoxin attenuates calcification of vascular smooth muscle cells via RUNX-2 signaling pathways

Background@#Kalkitoxin (KT) is an active lipopeptide isolated from the cyanobacterium Lyngbya majuscula found in the bed of the coral reef. Although KT suppresses cell division and inflammation, KT’s mechanism of action in vascular smooth muscle cells (VSMCs) is unidentified. Therefore, our main aim was to investigate the impact of KT on vascular calcification for the treatment of cardiovascular disease. @*Objectives@#Using diverse calcification media, we studied the effect of KT on VSMC calcification and the underlying mechanism of this effect. @*Methods@#VSMC was isolated from the 6 weeks ICR mice. Then VSMCs were treated with different concentrations of KT to check the cell viability. Alizarin red and von Kossa staining were carried out to examine the calcium deposition on VSMC. Thoracic aorta of 6 weeks mice were taken and treated with different concentrations of KT, and H and E staining was performed. Real-time polymerase chain reaction and western blot were performed to examine KT’s effect on VSMC mineralization. Calcium deposition on VSMC was examined with a calcium deposition quantification kit. @*Results@#Calcium deposition, Alizarin red, and von Kossa staining revealed that KT reduced inorganic phosphate-induced calcification phenotypes. KT also reduced Ca++ -induced calcification by inhibiting genes that regulate osteoblast differentiation, such as runtrelated transcription factor 2 (RUNX-2), SMAD family member 4, osterix, collagen 1α, and osteopontin. Also, KT repressed Ca2+ -induced bone morphogenetic protein 2, RUNX-2, collagen 1α, osteoprotegerin, and smooth muscle actin protein expression. Likewise, Alizarin red and von Kossa staining showed that KT markedly decreased the calcification of ex vivo ring formation in the mouse thoracic aorta. @*Conclusions@#This experiment demonstrated that KT decreases vascular calcification and may be developed as a new therapeutic treatment for vascular calcification and arteriosclerosis.

Treatment Results of Treatment-naïve Neovascular Age-related Macular Degeneration in Patients Over 85 Years of Age

Purpose@#To investigate the characteristics and treatment results of patients aged ≥ 85 years who were diagnosed with treatment-naïve neovascular age-related macular degeneration (nAMD). @*Methods@#The medical records of patients diagnosed with treatment-naïve nAMD who were ≥ 85 years old at the time of diagnosis with at least 12 months follow-up were retrospectively reviewed. The number of intravitreal injections of anti-vascular endothelial growth factor (VEGF) and agents used during the entire period were investigated. Best-corrected visual acuity and optical coherence tomography results before and after treatment were analyzed. Visual acuity of the fellow eye was also collected. @*Results@#A total of 40 eyes of 40 patients with mean age of 87.5 ± 2.4 were included in the study. The mean logarithm of the minimal angle of resolution visual acuity was 0.85 ± 0.57, and the mean of the fellow eye was 0.93 ± 0.99. Compared to before the treatment, there was no significant difference after intravitreal injection in terms of visual acuity. Central retinal thickness showed significant reduction at all time points after treatment. @*Conclusions@#In patients aged ≥ 85 years at the time of diagnosis, intravitreal injections of anti-VEGF prevented deterioration of visual acuity and showed successful anatomical outcomes. Especially, many had poor visual acuity in the fellow eye, suggesting the importance of maintaining visual acuity. Therefore, active treatment is necessary in the elderly.

Modified Rectangular Loop Suture for Refractory Pupillary Optic Capture of Scleral Fixated Intraocular Lens

Purpose@#To report a modified rectangular loop suture technique for patients with refractory pupillary optic capture after intraocular lens scleral fixation. @*Methods@#A modified rectangular loop suture was performed in four patients with persistent pupillary capture despite medication and laser iridotomy. A loop suture pattern was designed in the two quadrants without the scleral fixation knot. A 2 mm loop suture point was marked 2 mm away from the corneal limbus. The suture point was similarly marked in the opposite quadrants. Small conjunctival incisions were made at a marked point and a non-absorbable 10-0 prolene long needle was passed. The needle was inserted at the 1 o’clock position through the conjunctival incision and passed between the intraocular lens and the iris plane. Then it was withdrawn using a 26-gauge (G) syringe from the 8 o’clock position in the opposite quadrant. Similarly, the needle was passed from the 7 o’clock position under the conjunctiva, and pulled out of the sclera at the 2 o’clock position. It was then passed to the 1 o’clock position under the conjunctiva and a knot was made and buried. The operation was completed without closure of the conjunctival incision. @*Results@#In all four eyes, pupillary optic capture was corrected and remained stable without recurrence for an average of 7.25 months. @*Conclusions@#The modified rectangular loop suture may be useful for refractory pupillary capture cases. The procedure is relatively simple and minimizes scleral exposure to the conjunctival suture. It is expected that this may reduce patient discomfort.

Medial Arterial Calcification and the Risk of Amputation of Diabetic Foot Ulcer in Patients With Diabetic Kidney Disease

We assessed the risk factors for major amputation of diabetic foot ulcers (DFUs) in patients with diabetic kidney disease (DKD) stages 3b–5. For DFU assessment, in addition to DFU location and presence of infection, ischemia, and neuropathy, vascular calcification was assessed using the medial arterial calcification (MAC) score. Of 210 patients, 26 (12.4%) underwent major amputations. Only the location and extension of DFU, represented by Texas grade differed between the minor and major amputation groups. However, after adjusting for covariates, ulcer location of mid- or hindfoot (vs. forefoot, odds ratio [OR] = 3.27), Texas grades 2 or 3 (vs. grade 0, OR = 5.78), and severe MAC (vs. no MAC, OR = 4.46) was an independent risk factor for major amputation (all P < 0.05). The current use of antiplatelets was a possible protective factor for major amputations (OR = 0.37, P = 0.055). In conclusion, DFU with severe MAC is associated with major amputation in patients with DKD.

Textural and Volumetric Changes of the Temporal Lobes in Semantic Variant Primary Progressive Aphasia and Alzheimer’s Disease

Background@#Texture analysis may capture subtle changes in the gray matter more sensitively than volumetric analysis. We aimed to investigate the patterns of neurodegeneration in semantic variant primary progressive aphasia (svPPA) and Alzheimer’s disease (AD) by comparing the temporal gray matter texture and volume between cognitively normal controls and older adults with svPPA and AD. @*Methods@#We enrolled all participants from three university hospitals in Korea. We obtained T1-weighted magnetic resonance images and compared the gray matter texture and volume of regions of interest (ROIs) between the groups using analysis of variance with Bonferroni posthoc comparisons. We also developed models for classifying svPPA, AD and control groups using logistic regression analyses, and validated the models using receiver operator characteristics analysis. @*Results@#Compared to the AD group, the svPPA group showed lower volumes in five ROIs (bilateral temporal poles, and the left inferior, middle, and superior temporal cortices) and higher texture in these five ROIs and two additional ROIs (right inferior temporal and left entorhinal cortices). The performances of both texture- and volume-based models were good and comparable in classifying svPPA from normal cognition (mean area under the curve [AUC] = 0.914 for texture; mean AUC = 0.894 for volume). However, only the texture-based model achieved a good level of performance in classifying svPPA and AD (mean AUC = 0.775 for texture; mean AUC = 0.658 for volume). @*Conclusion@#Texture may be a useful neuroimaging marker for early detection of svPPA in older adults and its differentiation from AD.

Comparative Analysis on the Policy Approaches in the National Dementia Plans of G7 Countries and Korea and Their Implementation

Background@#The World Health Organization (WHO) proposed a global action plan for dementia and aimed to have 75% of their member states formulating National Dementia Plans (NDPs) by 2025. The Organization for Economic Cooperation and Development (OECD) proposed the ten key objectives of dementia policy in 2015. Among previous studies on NDPs, few studies have investigated measures for proper implementation of NDPs. This study aimed to compare the implementation basis and specific action plans of NDPs between the G7 countries and South Korea. @*Methods@#We investigated the measures for proper implementation of the NDPs of G7 countries and South Korea. To compare the specific policy approaches, the seven action areas of the WHO action plan and the ten key objectives of dementia policy proposed by the OECD were integrated into 11 targets (prevention, diagnosis, awareness, caregiver support, appropriate environments, long-term care, health service, end-of-life care, care coordination, research and technology, information systems). @*Results@#Although most NDPs included specific action plans of the 11 targets, caregiver support, safe environments, healthcare services, and end-of-life care were lacking in some NDPs. For implementation, some countries reinforced the policy priority of their NDPs by timely updates, evaluation, legislations, or head-of-state leadership. However, only three countries had a legislative basis, and three countries included outcome measures in their latest NDP. @*Conclusion@#Effective measures for feasible implementation are needed. The WHO should promote not only the establishment of NDPs, but also their proper implementation.

Toward a complete cure for chronic hepatitis B: Novel therapeutic targets for hepatitis B virus

Hepatitis B virus (HBV) affects approximately 250 million patients worldwide, resulting in the progression to cirrhosis and hepatocellular carcinoma, which are serious public health problems. Although universal vaccination programs exist, they are only prophylactic and not curative. In the HBV life cycle, HBV forms covalently closed circular DNA (cccDNA), which is the viral minichromosome, in the nuclei of human hepatocytes and makes it difficult to achieve a complete cure with the current nucleos(t)ide analogs and interferon therapies. Current antiviral therapies rarely eliminate cccDNA; therefore, lifelong antiviral treatment is necessary. Recent trials for antiviral treatment of chronic hepatitis B have been focused on establishing a functional cure, defined by either the loss of hepatitis B surface antigen, undetectable serum HBV DNA levels, and/or seroconversion to hepatitis B surface antibody. Novel therapeutic targets and molecules are in the pipeline for early clinical trials aiming to cure HBV infection. The ideal strategy for achieving a long-lasting functional or complete cure might be using combination therapies targeting different steps of the HBV life cycle and immunomodulators. This review summarizes the current knowledge about novel treatments and combination treatments for a complete HBV cure.

The Effect of Stress on Anxiety and Depressed Mood and the Mediating Effect of Resilience in Medical Residents and Interns During Coronavirus Disease-19 Event / 정신신체의학

Objectives@#: In this study, we evaluate psychological stress, symptoms of anxiety and depressed mood and resilience which medical residents and interns perceived during COVID-19 event, then investigate the associations between stress and the symptoms and mediating effect of resilience on the associations. @*Methods@#: In this study, we made a self-reporting form to evaluate psychological stress with perceived stress scale (PSS), symptoms of anxiety and depressed mood with Hospital anxiety and depression scale (HAD), and resilience with Conner-Davidson Resilience Scale (CD-RISC). Medical residents and interns, who worked in a hospital during COVID-19 event, filled the self-reporting forms from july, 2020 to august, 2020. We conducted a Pearson correlation coefficient and a multiple regression to confirm association between psychological stress and symptoms of anxiety and depressed mood, then mediating effect of resilience. @*Results@#: The higher stress perceived, the more symptoms of anxiety and depressed mood were reported by medical residents and interns. The higher resilience is associated with lower stress and less symptoms of anxiety and depressed mood, which resilience is proven to mediate partially the association between stress and symptoms of depressed mood. @*Conclusions@#: This study shows that resilience has a partial mediating effects on the association between stress and psychological pathology especially depressed mood, given that medical residents and interns were under psychological distress during COVID-19 event. This suggests that resilience is the key for medical trainees to overcome the future crisis like COVID-19 event.

The Effect of Second-Generation Antipsychotics Administration for 1-Year on the Platelet Activities in Patients With Schizophrenia: Retrospective Study / 정신신체의학

Objectives@#：This study was conducted to investigate the effect of 1-year administration of second-generation antipsychotics (SGAs) on the platelet activity in patients with schizophrenia through a retrospective review of the medical records. @*Methods@#：The mean platelet component (MPC) value was used as an index of the platelet activity. The included subjects (N=24) were the patients who were confirmed to have taken SGAs continuously for one year after the first MPC measurement had been performed. The change of MPC was verified through a paired sample t-test. @*Results@#：The result revealed that the mean MPC value was significantly decreased from 26.5±1.4 g/dL to 25.6±1.8 g/dL after 1-year administration of SGAs from the time of the first MPC measurement. @*Conclusions@#：This study suggests that 1-year administration of SGAs may be related with increased platelet activity, and that close monitoring for risks such as cerebrovascular/cardiovascular or thromboembolic diseases may be necessary during SGAs treatment in clinical practice.

The Empathy and Justice Contemplated From the Neuroscientific Perspective in the Age of Social Divisions and Conflicts / 정신신체의학

Although humans exist as Homo Empathicus, human society is actually constantly divided and conflicted between groups. The human empathy response is very sensitive to the justice of others, and depending on the level of others’ justice, they may feel empathy or schadenfreude to the suffering of them. However, our empathy to others’ suffering are not always fair, and have inherent limitations of ingroup-biased empathy. Depending on whether the suffering other persons belongs to an ingroup or an outgroup, we may feel biased empathy or biased schadenfreude to them without even realizing it. Recent advances in information and communication technology facilitate biased access to ingroup-related SNS or ingroup media, thereby deepening the establishment of a more biased semantic information network related groups. These processes, through interacting with the inherent limitation of empathy, can form a vicious cycle of more biased ingroup empathy and ingroup-relat-ed activities, and accelerate divisions and conflicts. This research investigated the properties and limitations of empathy by reviewing studies on the neural mechanism of empathy. By examining the relationship between empathy and justice from a neuroscientific point of view, this research tried to illuminate the modern society of di-vision and conflict in a different dimension from the classical perspective of social science.

Endoscopic Ultrasonography-guided Gastrojejunostomy for Patients with Gastric Outlet Obstruction and Pyloric Metal Stent Dysfunction / 대한소화기학회지

A 52-year-old woman with a gastric outlet obstruction (GOO) caused by pyloric cancer underwent pyloric endoscopic self-expandable metal stent (SEMS) insertion. She presented with abdominal distension 40 days later. The SEMS was dysfunctional, and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) was performed using an endoscopic nasobiliary drainage tube. A 16 mm×31 mm Niti-S ™ HOT SPAXUS™ (TaeWoong Medical, Gimpo, Korea) was inserted successfully between the stomach and the adjacent jejunum. After the procedure, the patient had a good oral intake for more than seven months. GOO is a mechanical obstructive condition caused by various benign and malignant conditions. Traditionally, surgical GJ and SEMS insertion have been used to treat GOOs. EUS-GJ is a feasible treatment option for patients with GOO and a pyloric metal stent dysfunction.

Retinol-binding protein-4 was associated with sensitization to inhalant allergens in the elderly population

Background/Aims@#Recent evidence suggests an association between allergic sensitization and metabolic markers. However, this association has rarely been examined in the elderly. Retinol-binding protein-4 (RBP-4) is a recently identified adipokine that acts on the muscle and liver affecting insulin sensitivity. We evaluated the association between metabolic parameters and allergic sensitization in the elderly. @*Methods@#We analysed the database of the Korean Longitudinal Study on Health and Aging cohort study conducted during 2005 to 2006. Atopy was identified by inhalant allergen skin prick test. Metabolic conditions were assessed using anthropometric indices and serum biomarkers such as fasting glucose, lipid, adiponectin, and RBP-4. @*Results@#Among the 854 elderly subjects, 17.2% had atopy. Plasma RBP-4 levels were significantly higher in the atopic elderly than nonatopic elderly (p = 0.003). When RBP-4 percentiles were categorized as under three groups, the prevalence of atopy and current rhinitis increased significantly with percentiles of RBP-4 levels (p = 0.019 and p = 0.007, respectively). Log RBP-4 was associated with atopy (odds ratio [OR], 4.10; p = 0.009) and current rhinitis (OR, 2.73; p = 0.014), but not with current asthma (OR, 1.17; p = 0.824). Higher RBP-4 level in atopic elderly was also observed in current rhinitis patients. Atopy, but not current rhinitis, showed significant relationships with log RBP-4 levels in multivariate analyses adjusted for other metabolic markers including body mass index. @*Conclusions@#RBP-4 positively associated with atopy in the general elderly population irrespective of other metabolic markers.

One-year Results of Aflibercept Treatment for Polypoidal Choroidal Vasculopathy with Good Visual Acuity

Purpose@#To evaluate the one-year efficacy of intravitreal aflibercept injection in polypoidal choroidal vasculopathy (PCV) with best-corrected visual acuity (BCVA) of 20 / 40 or better. @*Methods@#This was a multicenter retrospective study. The medical records of patients diagnosed with treatment-naïve PCV were retrospectively reviewed. Patients with an initial BCVA of 20 / 40 or better and who had undergone intravitreal aflibercept injection were included. Patients were treated with three consecutive monthly injections, followed by pro re nata regimen according to the clinician’s discretion at variable interval visits. The proportions of eyes for which BCVA was maintained (≤ 0.2 logarithm of the minimum angle of resolution change) or improved at 12 months were evaluated. The changes of BCVA, central subfield macular thickness (CSMT), pigment epithelial detachment, and subretinal fluid also were assessed. @*Results@#A total of 86 eyes were included. The mean number of injections for 12 months of treatment was 5.4 ± 1.7. BCVA was maintained or improved in 94.2% (81 / 86) of cases. Mean BCVA (logarithm of the minimum angle of resolution) had changed from the baseline (0.23 ± 0.09) at 3 months (0.21 ± 0.14), 6 months (0.24 ± 0.22), and 12 months (0.20 ± 0.18), but with no statistical significance. CSMT had improved significantly from the baseline (336.1 ± 97.3 μm) at 3 months (223.6 ± 47.22 μm), 6 months (239.6 ± 64.2 μm), and 12 months (223.8 ± 47.9 μm). Pigment epithelial detachment was observed in 93% of cases at the baseline, 72.1% at 3 months, and 69.8% at 12 months, showing a significant decrease at all observation points. Subretinal fluid was observed in 91.9% of cases at the baseline, 20.9% at 3 months, and 29.1% at 12 months, showing a significant decrease at all observation points. @*Conclusions@#In cases of PCV with good visual acuity, intravitreal aflibercept injections decreased CSMT and were effective in maintaining visual acuity.

The Effects of COVID-19 on the Self-Harm in Children and Adolescents Observed in a University Hospital / 정신신체의학

Objectives@#：The aim of the present study is to investigate the impact of COVID-19 on the incidence and severity of childhood and adolescent self-harm. @*Methods@#：Medical records were retrospectively reviewed for patients under the age of 18 who visited the emergency room of Konyang University Hospital to compare the rate of self-harm attempts and the demographic, clinical, and self-harm-related of self-harm attempters aspects before and after the COVID-19 outbreak. @*Results@#：During 11 months after the COVID-19 outbreak, the proportion of the number of children and adolescents patients with self-harm and their episodes increased significantly compared to that during 11 months be-fore the COVID-19 outbreak (χ2 =14.397, p<0.001; χ2 =24.156, p<0.001). Between about the year before and after the outbreak of COVID-19, there was a significant difference in the prior self-harm history and psychiatric history among children and adolescents who visited the emergency room and the ratio of hospitalization to other departments than department of psychiatry (p<0.05; p<0.05; p<0.05). @*Conclusions@#：In the COVID-19 situation, the proportion of children and adolescents who visited the emergency room due to self-harm and admission to other departments are increasing. And it has been shown that the inci-dence of self-harm has significantly increased in children and adolescents with a history of prior self-harm and psychiatric past history. These findings underscore the need for the psychiatric evaluation and intervention of self-harm related high-risk groups among children and adolescents in pandemic situations.

Survey of AREDS2 Formula Intake in Korean Patients with Age-related Macular Degeneration

Purpose@#To investigate the use of second AREDS2 formula in patients with intermediate or advanced age-related macular degeneration. @*Methods@#A prospective survey was conducted between December 2019 and July 2020. The questionnaire consisted of 24 questions on demographics, disease perception, and formula intake. @*Results@#The survey included 100 patients (males, 56%; age [>60 years], 89%). We found that 66%, 84%, and 93% of patients had a good understanding of their disease, had stopped smoking, and were aware of the need for antioxidant supplements; 58% of patients were aware of the supplement they were prescribed, and 63.8% (37% of total) were using the AREDS2 formula. Only 8% of patients had knowledge regarding the supplement ingredients, and 91% consumed the supplement daily. Patients with long disease duration used supplements less frequently (p < 0.05). Older patients and those with a low education level had a limited perception of the disease (p < 0.05). @*Conclusions@#In this prospective survey, some patients consumed supplements other than the AREDS2 formula. Further studies are required to determine ways to increase the use of the AREDS2 formula.

Content analysis of error disclosure communication of emergency medicine residents in simulation using standardized patient / 의료커뮤니케이션

Background@#: We analyze the contents of conversations of emergency medicine (EM) residents in a simulation using standardized patients in error disclosure education, and examine the characteristics of them. @*Methods@#: Error disclosure education program was conducted for 15 EM residents at a training hospital. One case of near miss and one case of adverse event were developed, and all 15 residents participated in each case. The contents of 30 error disclosure conversation were analyzed. @*Results@#: Residents talked more in ‘Acknowledge what happened’ and ‘Response/Plan for care’, and it was rare to have conversations of ‘Tell me about it’ or ‘Answer questions’ in both cases. The cause of the incident was explained frankly, but when the patient blamed there were some residents who told honestly or not. There was a tendency to vaguely reveal the subject who made the mistake or attribute it to another cause. Most of residents apologized to the patient. Most of residents explained systematic recurrence prevention measures and compensation plans, but there were cases where the contents were not specific or inaccurate. Throughout the entire phase, the expression “we” was often used. @*Conclusion@#: Residents had doctor-led conversations while error disclosure, so that they need more patient-centered conversations. When apology, empathy and regret should be conveyed in various expressions. Residents need to be properly trained and able to explain to patients about follow-up measures such as systematic recurrence prevention measures and compensation plans. These results can be a basic material for teaching error disclosure or guidelines.

Difference of Perceived Readiness for Interprofessional Learning among Medical and Nursing Students after Simulation-based Interprofessional Education / 의료커뮤니케이션

Background@#The purpose of this study was to investigate the differences of readiness for interporfessional learning before and after applying a simulation-based interprofessional education (sim-IPE) program among medical and nursing students. @*Methods@#This study used one-group pretest-posttest design. A sim-IPE program was implemented for 94 medical and 41 nursing students during half a day. The program was consisted of team building games, simulation, board games, and case discussion. The readiness for interprofessional learning scale (RIPLS) which is a 5-point Likert type and has four domains was used to assess students’ perceptions pre- and post-IPE program. Also, students were requested to write three words that immediately came to mind when they saw a word of ‘teamwork’. Data were analyzed by frequency, mean and standard deviation, paired t-test, and Cronbach’s alpha. @*Results@#A total scores of RIPLS significantly increased from 78.3 to 86.7 points after implementing a simulation-based IPE program (t=-14.80, p<.001). Among the most submitted words by students, a ranking of ‘communication’ has risen from fifth pre-IPE to second post-IPE. @*Conclusions@#Based on the results form our study, a simulation-based IPE program provides a very valuable educational opportunity for students to increase positive attitude to interprofessional learning. A variety of IPE programs should be developed and incorporated in all healthcare professional curriculums.

Prevalence and characteristics of isolated nocturnal hypertension in the general population

Background/Aims@#Ascertaining the prevalence of isolated nocturnal hypertension (INHT) in the general population and identifying the characteristics of patients with INHT may be important to determine patients who should receive 24- hour ambulatory blood pressure (BP) measurements. This study aimed to evaluate the prevalence and characteristics of INHT in the general population. @*Methods@#Of 1,128 participants (aged 20 to 70 years), we analyzed 823 who had valid 24-hour ambulatory BP measurements and were not on antihypertensive drug treatment. @*Results@#The prevalence of INHT in the study was 22.8%. Individuals with INHT had a higher office, 24-hour, and daytime and nighttime ambulatory systolic and diastolic BPs compared to individuals with sustained day-night normotension. INHT was more prevalent in individuals with masked hypertension (MH) than in those with sustained hypertension (59.8% vs. 15.6%, p < 0.001). Among individuals with INHT, 92.6% had MH. Among individuals with office BP-based prehypertension, 34.5% had both INHT and MH. The prevalence of INHT was highest in individuals with office BP-based prehypertension. INHT was an independent determinant of MH after adjustment for age, sex, body mass index, diabetes, low-density-lipoprotein cholesterol, 24-hour systolic and diastolic BP, systolic and diastolic BP dipping, and systolic and diastolic BP non-dipping. @*Conclusions@#The present study showed that INHT is not uncommon and is a major determinant of MH. Our findings strongly suggest the use of 24-hour ambulatory BP measurement for individuals within the prehypertension range of office BP owing to the high prevalence of INHT and MH in this population.

Cannulation of the Portal Vein during Endoscopic Retrograde Cholangiopancreatography in a Patient with Choledocholithiasis / 대한소화기학회지

Cannulation of the portal vein is a rare complication of ERCP. This paper reports a case of portal vein catheterization during ERCP in a patient with choledocholithiasis. A 62-year-old man was admitted to the Presbyterian Medical Center with right upper quadrant pain and jaundice. ERCP was performed under the suspicion of obstructive jaundice caused by a radiolucent stone. Bile duct cannulation using a pull-type papillotome was attempted, but it failed. After needle-knife fistulotomy, wire-guided cannulation was performed successfully, and 10 mL contrast was injected. On the other hand, the fluoroscopy image showed that the contrast medium disappeared very quickly. Pure blood was collected when the catheter was aspirated to identify the bile reflux, indicating possible cannulation of the portal vein. The procedure was terminated immediately and abdominal computed tomography showed air in the portal vein. One day after, a follow-up CT scan showed no air in the portal vein. The patient underwent repeated ERCP, and the common bile duct was cannulated. In most cases, isolated portal vein cannulation does not result in severe morbidity. However, it is important to aware of this rare complication so that no further invasive procedure is performed on the patient.