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Objective@#We aimed to elucidate public mental health problems and associated factors during the coronavirus disease-2019 (COVID-19). Furthermore, we evaluated people’s attitudes toward digital therapeutics during the pandemic. @*Methods@#Data was collected online from participants, aged between 20–50 without any history of mental illness, from June 1st to June 30th 2021. The survey consisted of questions regarding demographics, changes during pandemic and attitude towards digital therapeutics, and mental health measures. @*Results@#Among the total of 445 participants, 49.2% reported significant level of stress and 13.5% and 7.0% met the screening criteria for major depressive disorder and generalized anxiety disorder, respectively. Significant predictive factors for mental health problems were-younger age group, female sex, currently being treated for medical or surgical disease, change in the amount of time spent on mobile device or computer after pandemic, change in household income, and change in work environment due to pandemic. Furthermore, 35.1% of participants, considered psychiatric consultation, at least slightly, but were hesitant to receive it due to the fear of contacting COVID-19 at the clinics. Instead, 54.4% of them preferred using digital therapeutics as an alternative to visiting offline clinics. @*Conclusion@#We demonstrated that COVID-19 increased mental health problems along with access problems and identified their predictive factors. Digital therapeutics emerged as a viable solution to mental health problems and it was well-received by those in need of psychiatric consultation. Therefore, development and implementation of digital therapeutics should be considered to improve the mental health of people.
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Background@#and Purpose All young males in South Korea must undergo a physical examination for their participation in military service. We aimed to determine the prevalence rate (PR) of various neuromuscular diseases in young South Korean males using the data of exempted patients and soldiers. @*Methods@#The number of males exempted based on specific items of physical examination corresponding to neuromuscular disease during 2011–2020 were obtained from the records of the Military Manpower Administration. The list of enlisted soldier patients who were discharged from military service due to neuromuscular diseases during 2011–2020 was obtained from the Armed Forces Medical Command, and their medical records were reviewed. @*Results@#The PR of neuromuscular diseases was calculated among 948 identified males: 713 exempted males and 235 soldiers. The PRs of overall hereditary neuropathies, Hirayama disease (HD), myasthenia gravis (MG), and inherited muscle diseases in South Korean males in their early 20s were 8.34 (95% confidence interval [CI], 7.39–9.30), 5.54 (95% CI, 4.76–6.32), 2.97 (95% CI, 2.40–3.55), and 10.38 (95% CI, 9.31–11.46) per 100,000 persons, respectively.Among the enlisted soldiers, hereditary neuropathy with liability to pressure palsy was the most common neuromuscular disease, with a prevalence among the enlisted soldiers of 3.11 (95% CI, 2.42–3.80) per 100,000 persons. Myotonic dystrophy was the most prevalent myopathy, followed by facioscapulohumeral muscular dystrophy. @*Conclusions@#The 10-year PRs of hereditary polyneuropathies, HD, MG, and inherited muscle diseases in young South Korean males have been reported. These data could be valuable to understanding each neuromuscular disease in the young male population of South Korea.
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Objective@#To categorize multiparametric MRI features of Bacillus Calmette–Guérin (BCG)-related granulomatous prostatitis (GP) and discover potential manifestations for its differential diagnosis from prostate cancer. @*Materials and Methods@#The cases of BCG-related GP in 24 male (mean age ± standard deviation, 66.0 ± 9.4 years; range, 50–88 years) pathologically confirmed between January 2011 and April 2019 were retrospectively reviewed. All patients underwent intravesical BCG therapy followed by a MRI scan. Additional follow-up MRI scans, including diffusion-weighted imaging (DWI), were performed in 19 patients. The BCG-related GP cases were categorized into three: A, B, or C. The lesions with diffusion restriction and homogeneous enhancement were classified as type A. The lesions with diffusion restriction and a poorly enhancing component were classified as type B. A low signal intensity on high b-value DWI (b = 1000 s/mm2 ) was considered characteristic of type C. Two radiologists independently interpreted the MRI scans before making a consensus about the types. @*Results@#The median lesion size was 22 mm with the interquartile range (IQR) of 18–26 mm as measured using the initial MRI scans. The lesion types were A, B, and C in 7, 15, and 2 patients, respectively. Cohen’s kappa value for the inter-reader agreement for the interpretation of the lesion types was 0.837. On the last follow-up MRI scans of 19 patients, the size decreased (median, 5.8 mm; IQR, 3.4–8.5 mm), and the type changed from A or B to C in 11 patients. The lesions resolved in four patients. In five patients who underwent prostatectomy, caseous necrosis on histopathology matched with the non-enhancing components of type B lesions and the entire type C lesions. @*Conclusion@#BCG-related GP demonstrated three imaging patterns on multiparametric MRI. Contrast-enhanced T1-weighted imaging and DWI may play a role in its differential diagnosis from prostate cancer.
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Although rare, acute subdural hematoma (ASDH) may occur after burr hole trephination (BHT) for chronic subdural hematoma (CSDH). It usually occurs in the hemisphere ipsilateral to the burr hole site and rarely in the hemisphere contralateral to the burr hole site. On computed tomography (CT), SDH is usually crescent-shaped and occasionally lentiform or biconvex, which can be misdiagnosed as epidural hematoma (EDH). In rare cases, ASDH may resolve spontaneously and rapidly. Here, we report a case of rapid spontaneous resolution of contralateral lentiform ASDH after BHT for CSDH in a patient with brain atrophy. A 55-year-old man developed left CSDH 2 months after traumatic brain injury. Left BHT was performed, and a lentiform hematoma, presumed to be EDH, was found in the right frontal region on the CT scan acquired immediately after BHT. On the CT scan acquired 12 hours later, the lentiform hematoma disappeared and spread along the hemisphere. It was presumed to be ASDH. To prevent contralateral ASDH after BHT, slow decompression and minimal gentle or no irrigation should be performed during BHT, particularly in patients with brain atrophy.
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Abnormal aggregation of α-synuclein is a key element in the pathogenesis of several neurodegenerative diseases, including Parkinson’s disease (PD), dementia with Lewy bodies, and multiple system atrophy. α-synuclein aggregation spreads through various brain regions during the course of disease progression, a propagation that is thought to be mediated by the secretion and subsequent uptake of extracellular α-synuclein aggregates between neuronal cells. Thus, aggregated forms of this protein have emerged as promising targets for disease-modifying therapy for PD and related diseases. Here, we generated and characterized conformation-specific antibodies that preferentially recognize aggregated forms of α-synuclein. These antibodies promoted phagocytosis of extracellular α-synuclein aggregates by microglial cells and interfered with cell-to-cell propagation of α-synuclein. In an α-synuclein transgenic model, passive immunization with aggregate-specific antibodies significantly ameliorated pathological phenotypes, reducing α-synuclein aggregation, gliosis, inflammation, and neuronal loss. These results suggest that conformation-specific antibodies targeting α-synuclein aggregates are promising therapeutic agents for PD and related synucleinopathies.
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Background@#Firefighters inevitably encounter emotionally and physically stressful situations at work. Even firefighters without diagnosed post-traumatic stress disorder receive clinical attention because the nature of the profession exposes them to repetitive trauma and high occupational stress. This study investigated gray matter abnormalities related to high occupational stress in firefighters using voxel-based morphometry (VBM) and surface-based morphometry (SBM). @*Methods@#We assessed 115 subjects (112 males and 3 females) using magnetic resonance imaging and evaluated occupational stress by the Korean Occupational Stress Scale-26 (KOSS-26). Subjects were classified into highly or lowly stressed groups based on the median value of the KOSS-26. @*Results@#In VBM analysis, we found that firefighters with high occupational stress had lower gray matter volume (GMV) in both sides of the insula, the left amygdala, the right medial prefrontal cortex (mPFC), and the anterior cingulate cortex than firefighters with low occupational stress. In SBM analysis based on regions of interest, the GMV of the bilateral insula and right mPFC were also lower in the highly stressed group. Within the highly stressed group, low GMV of the insula was significantly correlated with the length of service (left: r = −0.347, P = 0.009; right: r = −0.333, P = 0.012). @*Conclusion@#Our findings suggest that regional GMV abnormalities are related to occupational stress. Regional gray matter abnormalities and related emotional dysregulation may contribute to firefighter susceptibility to burnout.
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Stroke and cardiac disorders are difficult to approach separately. Stroke survivors commonly have cardiovascular comorbidities and vice versa. These patients often need both neurorehabilitation and cardiac rehabilitation; therefore, this is an important issue in the rehabilitation process. However, no consensus has been reached on the integration of cardiac rehabilitation and neurorehabilitation. We report the case of a 52-year-old male patient who had ischemic stroke after mitral valvuloplasty. The patient underwent 3 weeks of inpatient neurorehabilitation, and then transited to 6 weeks of outpatient cardiac rehabilitation and occupational therapy. After 9 weeks of well-integrated rehabilitation, the patient experienced neurologic recovery and improvement in his cardiopulmonary fitness. Like this case, successful integrated rehabilitation will contribute to enhancing patients' functional recovery.
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BACKGROUND@#The advantages of tonsil-derived mesenchymal stem cells (TMSCs) over other mesenchymal stem cells (MSCs) include higher proliferation rates, various differentiation potentials, efficient immune-modulating capacity, and ease of obtainment. Specifically, TMSCs have been shown to differentiate into the endodermal lineage. Estrogen deficiency is a major cause of postmenopausal osteoporosis and is associated with higher incidences of ischemic heart disease and cerebrovascular attacks during the postmenopausal period. Therefore, stem cell-derived, estrogen-secreting cells might be used for estrogen deficiency. @*METHODS@#Here, we developed a novel method that utilizes retinoic acid, insulin-like growth factor-1, basic fibroblast growth factor, and dexamethasone to evaluate the differentiating potential of TMSCs into estrogen-secreting cells. The efficacy of the novel differentiating method for generation of estrogen-secreting cells was also evaluated with bone marrow- and adipose tissue-derived MSCs. @*RESULTS@#Incubating TMSCs in differentiating media induced the gene expression of cytochrome P450 19A1 (CYP19A1), which plays a key role in estrogen biosynthesis, and increased 17b-estradiol secretion upon testosterone addition. Furthermore, CYP11A1, CYP17A1, and 3b-hydroxysteroid dehydrogenase type-1 gene expression levels were significantly increased in TMSCs. In bone marrow-derived and adipose tissue-derived MSCs, this differentiation method also induced the gene expression of CYP19A1, but not CYP17A1, suggesting TMSCs are a superior source for estrogen secretion. @*CONCLUSION@#These results imply that TMSCs can differentiate into functional estrogen-secreting cells, thus providing a novel, alternative cell therapy for estrogen deficiency.
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Objective@#To construct a CT-based Fagotti scoring system by analyzing the correlations between laparoscopic findings and CT features in patients with advanced ovarian cancer. @*Materials and Methods@#This retrospective cohort study included patients diagnosed with stage III/IV ovarian cancer who underwent diagnostic laparoscopy and debulking surgery between January 2010 and June 2018. Two radiologists independently reviewed preoperative CT scans and assessed ten CT features known as predictors of suboptimal cytoreduction. Correlation analysis between ten CT features and seven laparoscopic parameters based on the Fagotti scoring system was performed using Spearman’s correlation. Variable selection and model construction were performed by logistic regression with the least absolute shrinkage and selection operator method using a predictive index value (PIV) ≥ 8 as an indicator of suboptimal cytoreduction. The final CT-based scoring system was internally validated using 5-fold cross-validation. @*Results@#A total of 157 patients (median age, 56 years; range, 27–79 years) were evaluated. Among 120 (76.4%) patients with a PIV ≥ 8, 105 patients received neoadjuvant chemotherapy followed by interval debulking surgery, and the optimal cytoreduction rate was 90.5% (95 of 105). Among 37 (23.6%) patients with PIV < 8, 29 patients underwent primary debulking surgery, and the optimal cytoreduction rate was 93.1% (27 of 29). CT features showing significant correlations with PIV ≥ 8 were mesenteric involvement, gastro-transverse mesocolon-splenic space involvement, diaphragmatic involvement, and para-aortic lymphadenopathy. The area under the receiver operating curve of the final model for prediction of PIV ≥ 8 was 0.72 (95% confidence interval: 0.62–0.82). @*Conclusion@#Central tumor burden and upper abdominal spread features on preoperative CT were identified as distinct predictive factors for high PIV on diagnostic laparoscopy. The CT-based PIV prediction model might be useful for patient stratification before cytoreduction surgery for advanced ovarian cancer.
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Background@#Fabry disease is a rare X-linked genetic lysosomal disorder caused by mutations in the GLA gene encoding alpha-galactosidase A. Despite some data showing that profibrotic and proinflammatory cytokines and oxidative stress could be involved in Fabry disease-related renal injury, the pathogenic link between metabolic derangement within cells and renal injury remains unclear. @*Methods@#Renal fibrosis was triggered by unilateral ureteral obstruction (UUO) in mice with Fabry disease to investigate the pathogenic mechanism leading to fibrosis in diseased kidneys. @*Results@#Compared to kidneys of wild-type mice, lamellar inclusion bodies were recognized in proximal tubules of mice with Fabry disease. Sirius red and trichrome staining revealed significantly increased fibrosis in all UUO kidneys, though it was more prominent in obstructed Fabry kidneys. Renal messenger RNA levels of inflammatory cytokines and profibrotic factors were increased in all UUO kidneys compared to sham-operated kidneys but were not significantly different between UUO control and UUO Fabry mice. Protein levels of Nox2, Nox4, NQO1, catalase, SOD1, SOD2, and Nrf2 were not significantly different between UUO control and UUO Fabry kidneys, while the protein contents of LC3-II and LC3-I and expression of Beclin1 were significantly decreased in UUO kidneys of Fabry disease mouse models compared with wild-type mice. Notably, TUNEL-positive cells were elevated in obstructed kidneys of Fabry disease mice compared to wild-type control and UUO mice. @*Conclusion@#These findings suggest that impaired autophagy and enhanced apoptosis are probable mechanisms involved in enhanced renal fibrosis under the stimulus of UUO in Fabry disease.
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Ultrasonography is effective for imaging superficial organs, such as the scrotum. Using a highfrequency transducer, ultrasonography can identify the location and characteristics of scrotal lesions with high accuracy. The primary role of ultrasound (US) in the evaluation of a scrotal mass is to determine if it is intratesticular or extratesticular. Additional clinical information and other imaging options may be needed to diagnose benign tumors and pseudo-tumors. MRI is an effective problem-solving tool in cases with nondiagnostic US findings. CT is helpful for staging testicular cancer and localizing undescended testis. This review covers the imaging features of testicular and extratesticular tumors.
ABSTRACT
Ultrasonography is effective for imaging superficial organs, such as the scrotum. Using a highfrequency transducer, ultrasonography can identify the location and characteristics of scrotal lesions with high accuracy. The primary role of ultrasound (US) in the evaluation of a scrotal mass is to determine if it is intratesticular or extratesticular. Additional clinical information and other imaging options may be needed to diagnose benign tumors and pseudo-tumors. MRI is an effective problem-solving tool in cases with nondiagnostic US findings. CT is helpful for staging testicular cancer and localizing undescended testis. This review covers the imaging features of testicular and extratesticular tumors.
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Purpose@#Nearly one third of all patients with an eating disorder (ED) present with non-suicidal self-injury (NSSI). Although it is necessary to pay attention clinically to NSSI in ED patients due to an increased suicidal risk, there are limited data on potential predictors of NSSI in ED. We conducted this study to uncover predictors of NSSI in ED. @*Materials and Methods@#A total of 1355 ED patients who visited an ED clinic was evaluated through structured interviews by psychiatrists. The demographic and clinical characteristics of ED patients with NSSI (NSSI group) and ED patients without NSSI (non-NSSI group) were analyzed to identify potential predictors of NSSI in ED. @*Results@#Among all ED individuals, 242 (17.9%) reported a history of NSSI. Compared to the non-NSSI group, the NSSI group reported more severe eating symptomatology, more comorbid psychiatric disease, and more suicidal risk. Comorbid alcohol use disorder, depressive disorder, purging behavior, history of suicide attempt, and rumination symptoms were uncovered as predictors of NSSI in ED. @*Conclusion@#The findings of the study are meaningful in that they highlight predictors of NSSI in ED in a large clinical sample. Understanding risk factors of NSSI and offering appropriate interventions are important to preventing suicidality in ED.
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BACKGROUND@#The advantages of tonsil-derived mesenchymal stem cells (TMSCs) over other mesenchymal stem cells (MSCs) include higher proliferation rates, various differentiation potentials, efficient immune-modulating capacity, and ease of obtainment. Specifically, TMSCs have been shown to differentiate into the endodermal lineage. Estrogen deficiency is a major cause of postmenopausal osteoporosis and is associated with higher incidences of ischemic heart disease and cerebrovascular attacks during the postmenopausal period. Therefore, stem cell-derived, estrogen-secreting cells might be used for estrogen deficiency. @*METHODS@#Here, we developed a novel method that utilizes retinoic acid, insulin-like growth factor-1, basic fibroblast growth factor, and dexamethasone to evaluate the differentiating potential of TMSCs into estrogen-secreting cells. The efficacy of the novel differentiating method for generation of estrogen-secreting cells was also evaluated with bone marrow- and adipose tissue-derived MSCs. @*RESULTS@#Incubating TMSCs in differentiating media induced the gene expression of cytochrome P450 19A1 (CYP19A1), which plays a key role in estrogen biosynthesis, and increased 17b-estradiol secretion upon testosterone addition. Furthermore, CYP11A1, CYP17A1, and 3b-hydroxysteroid dehydrogenase type-1 gene expression levels were significantly increased in TMSCs. In bone marrow-derived and adipose tissue-derived MSCs, this differentiation method also induced the gene expression of CYP19A1, but not CYP17A1, suggesting TMSCs are a superior source for estrogen secretion. @*CONCLUSION@#These results imply that TMSCs can differentiate into functional estrogen-secreting cells, thus providing a novel, alternative cell therapy for estrogen deficiency.
ABSTRACT
Objective@#To construct a CT-based Fagotti scoring system by analyzing the correlations between laparoscopic findings and CT features in patients with advanced ovarian cancer. @*Materials and Methods@#This retrospective cohort study included patients diagnosed with stage III/IV ovarian cancer who underwent diagnostic laparoscopy and debulking surgery between January 2010 and June 2018. Two radiologists independently reviewed preoperative CT scans and assessed ten CT features known as predictors of suboptimal cytoreduction. Correlation analysis between ten CT features and seven laparoscopic parameters based on the Fagotti scoring system was performed using Spearman’s correlation. Variable selection and model construction were performed by logistic regression with the least absolute shrinkage and selection operator method using a predictive index value (PIV) ≥ 8 as an indicator of suboptimal cytoreduction. The final CT-based scoring system was internally validated using 5-fold cross-validation. @*Results@#A total of 157 patients (median age, 56 years; range, 27–79 years) were evaluated. Among 120 (76.4%) patients with a PIV ≥ 8, 105 patients received neoadjuvant chemotherapy followed by interval debulking surgery, and the optimal cytoreduction rate was 90.5% (95 of 105). Among 37 (23.6%) patients with PIV < 8, 29 patients underwent primary debulking surgery, and the optimal cytoreduction rate was 93.1% (27 of 29). CT features showing significant correlations with PIV ≥ 8 were mesenteric involvement, gastro-transverse mesocolon-splenic space involvement, diaphragmatic involvement, and para-aortic lymphadenopathy. The area under the receiver operating curve of the final model for prediction of PIV ≥ 8 was 0.72 (95% confidence interval: 0.62–0.82). @*Conclusion@#Central tumor burden and upper abdominal spread features on preoperative CT were identified as distinct predictive factors for high PIV on diagnostic laparoscopy. The CT-based PIV prediction model might be useful for patient stratification before cytoreduction surgery for advanced ovarian cancer.
ABSTRACT
Background@#Fabry disease is a rare X-linked genetic lysosomal disorder caused by mutations in the GLA gene encoding alpha-galactosidase A. Despite some data showing that profibrotic and proinflammatory cytokines and oxidative stress could be involved in Fabry disease-related renal injury, the pathogenic link between metabolic derangement within cells and renal injury remains unclear. @*Methods@#Renal fibrosis was triggered by unilateral ureteral obstruction (UUO) in mice with Fabry disease to investigate the pathogenic mechanism leading to fibrosis in diseased kidneys. @*Results@#Compared to kidneys of wild-type mice, lamellar inclusion bodies were recognized in proximal tubules of mice with Fabry disease. Sirius red and trichrome staining revealed significantly increased fibrosis in all UUO kidneys, though it was more prominent in obstructed Fabry kidneys. Renal messenger RNA levels of inflammatory cytokines and profibrotic factors were increased in all UUO kidneys compared to sham-operated kidneys but were not significantly different between UUO control and UUO Fabry mice. Protein levels of Nox2, Nox4, NQO1, catalase, SOD1, SOD2, and Nrf2 were not significantly different between UUO control and UUO Fabry kidneys, while the protein contents of LC3-II and LC3-I and expression of Beclin1 were significantly decreased in UUO kidneys of Fabry disease mouse models compared with wild-type mice. Notably, TUNEL-positive cells were elevated in obstructed kidneys of Fabry disease mice compared to wild-type control and UUO mice. @*Conclusion@#These findings suggest that impaired autophagy and enhanced apoptosis are probable mechanisms involved in enhanced renal fibrosis under the stimulus of UUO in Fabry disease.
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40 years or new hires with less than 1 year of service.
Subject(s)
Humans , Brain , Cardiovascular Diseases , Cohort Studies , Firefighters , Follow-Up Studies , Health Surveys , Hospitals, University , Killer Cells, Natural , Korea , Magnetic Resonance Imaging , Mental Disorders , Mental Health , Neuropsychological Tests , Polycyclic Aromatic Hydrocarbons , Prospective Studies , Republic of Korea , Risk FactorsABSTRACT
Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease that is caused by the novel virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 has become pandemic since December 2019, when the first case developed in Wuhan, China. Patients receiving hemodialysis are more vulnerable to viral transmission because their immune functions are impaired and they receive treatment within a narrow space. Calling on previous experience with Middle East Respiratory Syndrome during the 2015 outbreak, the joint committee of the Korean Society of Nephrology and the Korean Society of Dialysis Therapy quickly formed a COVID-19 task force team to develop a manual before the first index case was diagnosed in the hemodialysis unit. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within hemodialysis facilities, which were developed to protect patients, healthcare workers, and caregivers from this highly transmissible virus. The areas of infection control covered by these guidelines include standard precautions, performing dialysis therapy for confirmed or suspected cases, performing cohort isolation for contact patients, and disease monitoring and contact surveillance. We hope these guidelines help healthcare workers and hemodialysis patients around the world cope with the COVID-19 pandemic.
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Purpose@#The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Koreaby assessing National Health Insurance claims data. @*Methods@#The dataset included 70,136 patients aged 19 years who were inpatientsin psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia,schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registerednurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomesincluded length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint,and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and systemcharacteristics using multilevel modeling. @*Results@#Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatientsper registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission.More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnoticsuse but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injectedpsycholeptics for chemical restraint. @*Conclusion@#Lower nurse staffing levels are associated with negative health outcomes of psychiatricinpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatricinpatients in Korea.
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Immunoglobulin G4-related disease (IgG4-RD) is a fibro-inflammatory condition characterized by several pathological features that can theoretically involve all organs. Ovarian involvement in IgG4-RD has been reported by two studies only. Herein, we report a pathologically confirmed case of ovarian involvement of IgG4-RD, which mimicked bilateral ovarian malignancies on computed tomography and magnetic resonance imaging.