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Purpose@#Visual impairment, hearing impairment, and masticatory discomfort each influence quality of life (QoL). However, little is known regarding the impact of their coexistence on QoL. Therefore, we aimed to investigate the influence of the coexistence of visual impairment, hearing impairment, and masticatory discomfort on QoL among middle-aged adults aged 40-64. @*Methods@#This study involved a secondary data analysis utilizing the data from years 1 and 2 of the eighth Korea National Health and Nutrition Examination Survey. To evaluate the influence of the coexistence of visual impairment, hearing impairment, and masticatory discomfort on QoL, we conducted a complex sample hierarchical multiple regression analysis. @*Results@#When visual impairment, hearing impairment, and masticatory discomfort coexisted, the QoL was significantly lower than in individuals without any of these conditions. @*Conclusion@#The coexistence of visual impairment, hearing impairment, and masticatory discomfort was negatively correlated with QoL. Therefore, it is important to prepare for old age through appropriate health management during middle age.
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Background@#As female social participation increases, the importance of femininity in leadership also increases. In Korea in 2021, 26.8% of 132,013 doctors and 35.1% of 3,099 medical students were female. However, no research has been conducted on the gender demographics of medical leaders. This study aims to define Korean medical leadership, investigate the gender ratio, and determine whether the proportion of women leaders differs in the academic and non-academic worlds. @*Methods@#Korean medical leaders were defined as those in director or higher-level positions in organizations affiliated with the Korean Medical Association, 34 organizing societies under the Korean Academy of Medical Sciences (KAMS), and those who held dean and vice dean positions in 40 medical schools. Academic societies comprised KAMS, KAMS-affiliated societies, and medical schools; the rest were classified as non-academic organizations. Data were collected through website, e-mail, or telephonic surveys. Differences in the number of women leaders between academics and non-academics were analyzed using the chi-square test. @*Results@#In total, 1,863 medical leaders were evaluated, with females accounting for 12.6%. The difference in the ratio of female leaders between academic and non-academic societies was not statistically significant (13.1% academic vs. 11.8% non-academic; P=0.445). @*Conclusion@#The proportion of women leaders in the Korean medical field is relatively low compared with that of female doctors and medical students. The number of women in leadership positions and their effect on medical society will be observed periodically.
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Purpose@#Patient-derived tumor cells can be a powerful resource for studying pathophysiological mechanisms and developing robust strategies for precision medicine. However, establishing organoids from patient-derived cells is challenging because of limited access to tissue specimens. Therefore, we aimed to establish organoids from malignant ascites and pleural effusions. @*Materials and Methods@#Ascitic or pleural fluid from pancreatic, gastric, and breast cancer patients was collected and concentrated to culture tumor cells ex vivo. Organoids were considered to be successfully cultured when maintained for five or more passages. Immunohistochemical staining was performed to compare the molecular features, and drug sensitivity was assayed to analyze the clinical responses of original patients. @*Results@#We collected 70 fluid samples from 58 patients (pancreatic cancer, n=39; gastric cancer, n=21; and breast cancer, n=10). The overall success rate was 40%; however, it differed with types of malignancy, with pancreatic, gastric, and breast cancers showing 48.7%, 33.3%, and 20%, respectively. Cytopathological results significantly differed between successful and failed cases (p=0.014). Immunohistochemical staining of breast cancer organoids showed molecular features identical to those of tumor tissues. In drug sensitivity assays, pancreatic cancer organoids recapitulated the clinical responses of the original patients. @*Conclusion@#Tumor organoids established from malignant ascites or pleural effusion of pancreatic, gastric, and breast cancers reflect the molecular characteristics and drug sensitivity profiles. Our organoid platform could be used as a testbed for patients with pleural and peritoneal metastases to guide precision oncology and drug discovery.
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Purpose@#The genetic attribution for pancreatic ductal adenocarcinoma (PDAC) has been reported as 5%-10%. However, the incidence of germline pathogenic variants (PVs) in Korean PDAC patients has not been thoroughly investigated. Therefore, we studied to identify the risk factors and prevalence of PV for future treatment strategies in PDAC. @*Materials and Methods@#Total of 300 (155 male) patients with a median age of 65 years (range, 33 to 90 years) were enrolled in National Cancer Center in Korea. Cancer predisposition genes, clinicopathologic characteristics, and family history of cancer were analyzed. @*Results@#PVs were detected in 20 patients (6.7%, median age 65) in ATM (n=7, 31.8%), BRCA1 (n=3, 13.6%), BRCA2 (n=3), and RAD51D (n=3). Each one patient showed TP53, PALB2, PMS2, RAD50, MSH3, and SPINK1 PV. Among them, two likely PVs were in ATM and RAD51D, respectively. Family history of various types of cancer including pancreatic cancer (n=4) were found in 12 patients. Three patients with ATM PVs and a patient with three germline PVs (BRCA2, MSH3, and RAD51D) had first-degree relatives with pancreatic cancer. Familial pancreatic cancer history and PVs detection had a significant association (4/20, 20% vs. 16/264, 5.7%; p=0.035). @*Conclusion@#Our study demonstrated that germline PVs in ATM, BRCA1, BRCA2, and RAD51D are most frequent in Korean PDAC patients and it is comparable to those of different ethnic groups. Although this study did not show guidelines for germline predisposition gene testing in patients with PDAC in Korea, it would be emphasized the need for germline testing for all PDAC patients.
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Neck circumference is associated with a distinctive fat storage process that confers additional metabolic risk. Hence, this study aimed to investigate the correlation between baseline neck circumference and the incidence of cerebrovascular disease using a prospective community-based sample of Korean adults over 12 years of follow-up, after controlling for selected covariates. Methods: Participants with non-cerebrovascular disease were divided into 4 groups (Q1–Q4) based on their baseline neck circumference. Cox proportional hazards analysis was used to calculate hazard ratios and 95% confidence intervals (CIs) to evaluate the relationship between neck circumference and cerebrovascular disease incidence over a 12-year period. Results: Among this study’s 3,662 participants, 128 (3.50%) developed cerebrovascular disease. The incidence of cerebrovascular disease increased from 2.2% in Q1 to 4.3% in Q2, 2.5% in Q3, and 5.0% in Q4. When compared to Q1, the relative risks of cerebrovascular disease development were 0.57 (95% CI, 0.25–1.31), 0.86 (95% CI, 0.38–1.96), and 0.79 (95% CI, 0.30–2.07) in man and 1.86 (95% CI, 0.66–5.20), 3.50 (95% CI, 1.25–9.86), and 4.71 (95% CI, 1.50–14.77) in woman in Q2, Q3, and Q4, respectively, after adjusting for most risk factors related to cerebrovascular disease. Conclusion: The relationship between neck circumference and cerebrovascular disease was stronger in woman than in man, indicating potential differences between the sexes. These results are meaningful for evaluating and surveilling neck circumference as a promising tool for identifying subgroups of vulnerable and at-risk populations.
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Precise fluid administration is important to prevent hypo- or hypervolemia. However, the accuracy of scales marked on intravenous (IV) fluid plastic bags had remained unknown. Ten 1 L sized IV crystalloids were prepared from each of three manufacturers (H, J, and D). At each scale, the actual volume of the IV fluid was measured. Differences with the measured volumes for each scale were investigated between the three manufacturers. All initial total volume was greater than 1 L. Except for the full-filled level, H overfilled, whereas J and D filled less. For J and D, the maximal differences between the scale and the measured volume were about 200 mL. Fluid volumes of each scale were significantly different among the three manufacturers (P < 0.001). It is inaccurate to measure the amount of fluid depending on the IV bag scales. Clinicians must use electronic infusion pumps for accurate fluid administration.
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Objective@#To investigate long-term and serial functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia. @*Methods@#The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a large, multi-center, prospective cohort study of stroke patients admitted to participating hospitals in nine areas of Korea. From KOSCO, ischemic stroke patients without diabetes were recruited and divided into two groups: patients without diabetes without (n=779) and with post-stroke hyperglycemia (n=223). Post-stroke hyperglycemia was defined as a glucose level >8 mmol/L. Functional assessments were performed 7 days and 3, 6, and 12 months after stroke onset. @*Results@#There were no significant differences in baseline characteristics between the groups, except in the age of onset and smoking. Analysis of the linear correlation between the initial National Institutes of Health Stroke Scale (NIHSS) score and glucose level showed no significant difference. Among our functional assessments, NIHSS, Fugl-Meyer Assessment (affected side), Functional Ambulatory Category, modified Rankin Scale, and Korean Mini-Mental State Examination (K-MMSE) showed statistically significant improvements in each group. All functional improvements except K-MMSE were significantly higher in patients without post-stroke hyperglycemia at 7 days and 3, 6, and 12 months. @*Conclusion@#The glucose level of ischemic stroke patients without diabetes had no significant correlation with the initial NIHSS score. The long-term effects of stress hyperglycemia showed worse functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia.
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Whole-body vibration exercise (WBVe) can provide proper somatosensory stimulation and improve muscle strength in stroke patients. This study investigated the effects of WBVe on gait function and cortical activity in patients with chronic stroke. Thirty stroke patients were randomly assigned to either the WBVe or the control group. The WBVe group received the vibration in a half-squat position for 5 minutes at an intensity of 20 Hz. The control group kept the same posture but did not receive the vibration. Cortical activity was investigated using functional near-infrared spectroscopy (fNIRS). Gait function was assessed by a 10-m walk test (10MWT), a timed up and go (TUG) test, a Fugl-Meyer Assessment, and a Tinetti Performance-Oriented Mobility Assessment (TPOMA). In group analysis of the fNIRS data, oxygenated hemoglobin concentration was significantly increased in the ipsilesional supplementary motor area, bilateral sensorimotor cortex, and contralesional prefrontal cortex in the WBVe group compared to the control group (p < 0.05). Functional assessment demonstrated a significant interaction between time and group for the 10MWT and TUG test, suggesting that the WBVe group demonstrated meaningful improvement after intervention (p < 0.05). These results suggested that WBVe modulated the cerebral cortical activities and resulted in improvement of gait function in chronic stroke patients.
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Whole-body vibration exercise (WBVe) can provide proper somatosensory stimulation and improve muscle strength in stroke patients. This study investigated the effects of WBVe on gait function and cortical activity in patients with chronic stroke. Thirty stroke patients were randomly assigned to either the WBVe or the control group. The WBVe group received the vibration in a half-squat position for 5 minutes at an intensity of 20 Hz. The control group kept the same posture but did not receive the vibration. Cortical activity was investigated using functional near-infrared spectroscopy (fNIRS). Gait function was assessed by a 10-m walk test (10MWT), a timed up and go (TUG) test, a Fugl-Meyer Assessment, and a Tinetti Performance-Oriented Mobility Assessment (TPOMA). In group analysis of the fNIRS data, oxygenated hemoglobin concentration was significantly increased in the ipsilesional supplementary motor area, bilateral sensorimotor cortex, and contralesional prefrontal cortex in the WBVe group compared to the control group (p < 0.05). Functional assessment demonstrated a significant interaction between time and group for the 10MWT and TUG test, suggesting that the WBVe group demonstrated meaningful improvement after intervention (p < 0.05). These results suggested that WBVe modulated the cerebral cortical activities and resulted in improvement of gait function in chronic stroke patients.
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The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the ‘Return home’ group and 99 subjects in the ‘Rehabilitation hospitalization’ group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.
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The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from −4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.
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Although deep brain stimulation (DBS) has been reported to be effective to ameliorate motor and non-motor dysfunctions, freezing of gait (FoG) is often resistant to DBS in patients with Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) has been reported as an alternative therapeutic strategy to ameliorate FoG in PD patients. In this case report, we describe the effects of cumulative tDCS over the primary motor cortex of the lower leg to reduce FoG in 2 cases of PD patients with DBS. Two PD patients who had undergone DBS of the subthalamic nucleus visited the rehabilitation medicine department for refractory FoG. Each patient received cumulative tDCS over the primary motor cortex of the lower leg over to reduce FoG. Neither patient required change in dose of dopaminergic medication during the tDCS period nor a significant side effect during and after tDCS.Although the FoG-questionnaire (FoG-Q) in case 1 showed no change after 10 tDCS treatments, the patient in case 2 reported a significant improvement of FoG-Q from 11 to 3 after 5 days of tDCS. We present the safety and feasibility of tDCS in PD patients with DBS who showed refractory FoG.
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The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the ‘Return home’ group and 99 subjects in the ‘Rehabilitation hospitalization’ group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.
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The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from −4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.
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Although deep brain stimulation (DBS) has been reported to be effective to ameliorate motor and non-motor dysfunctions, freezing of gait (FoG) is often resistant to DBS in patients with Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) has been reported as an alternative therapeutic strategy to ameliorate FoG in PD patients. In this case report, we describe the effects of cumulative tDCS over the primary motor cortex of the lower leg to reduce FoG in 2 cases of PD patients with DBS. Two PD patients who had undergone DBS of the subthalamic nucleus visited the rehabilitation medicine department for refractory FoG. Each patient received cumulative tDCS over the primary motor cortex of the lower leg over to reduce FoG. Neither patient required change in dose of dopaminergic medication during the tDCS period nor a significant side effect during and after tDCS.Although the FoG-questionnaire (FoG-Q) in case 1 showed no change after 10 tDCS treatments, the patient in case 2 reported a significant improvement of FoG-Q from 11 to 3 after 5 days of tDCS. We present the safety and feasibility of tDCS in PD patients with DBS who showed refractory FoG.
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Objective@#This study investigated the effects of process-based cognitive training that targets working memory and cognitive control on memory improvement in healthy elderly individuals and patients with mild cognitive impairment (MCI). @*Methods@#Forty healthy subjects and 40 patients with MCI were randomly assigned to either the intervention or control group. The intervention group received 12 sessions of designated cognitive training. The control group did not receive cognitive training. A memory test was administered pre-intervention, post-intervention, and 4 weeks after the intervention. Additional comprehensive neuropsychological tests were also administered including a depression scale questionnaire. @*Results@#Performance in attention and working memory, which are directly related to the training domains, and global cognitive function were improved in the intervention group after training. In memory tests, interference by irrelevant stimuli was reduced and recognition memory was improved after the intervention. Furthermore, cognitive training ameliorated depressive symptoms. These training effects were not dependent on MCI status. @*Conclusion@#Process-based cognitive training that targets working memory and cognitive control effectively improves memory processes including retrograde interference and recognition, as well as depressive symptoms associated with aging in healthy elderly individuals and patients with MCI.
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Hyperthyroidism is a rare cause of dysphagia. We report a case of dysphagia as the first symptom of hyperthyroidism in a patient who improved with antithyroid agents and swallowing rehabilitation. An 81-year-old man was diagnosed with Graves’ disease after being hospitalized for recurrent aspiration symptoms that included cough and sputum for two months. The patient was given methimazole, propranolol, and Lugol solution as well as conventional swallowing rehabilitation for 60 minutes a day. Two weeks after initiation of treatment, the patient’s thyroid function tests saw improvement. He showed significant improvement in dysphagia after 3 weeks of treatment.Persisting improvement in swallowing was also found at 6 months post-treatment. Dysphagia may be the first symptom of hyperthyroidism in elderly patients, and physicians should consider performing thyroid function tests for evaluating such patients.
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Purpose@#Workers with chronic health problems find it difficult to maintain their work because of socioeconomic difficulties. The purpose of this study was to evaluate the relationships between physical, ergonomic, and mental health hazards in the workplace and chronic health problems of Korean workers. @*Methods@#A total of 28,807 wage workers participated in the study and were selected using the Fifth Korean Working Conditions Survey (2017).Multiple logistic regression analysis was used to determine the associations between physical, ergonomic, and mental health hazards and chronic health problems. @*Results@#Of the participants, 1,220 (4.23%) had chronic health problems. Even after adjusting the general characteristics, vibration, noise, high temperature, low temperature, dust, chemical and cigarette smoke, fatigue and painful posture, dragging or pushing or moving of heavy objects, repetitive hand or arm movements, working with a computer or smartphone, use of internet or e-mail, and anxiety situations increased the risk of chronic health problems. @*Conclusion@#The study reaffirms that exposure of physical, ergonomic, and mental health hazards in the workplace significantly increases the risk of chronic health problems.
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The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the ‘Return home’ group and 99 subjects in the ‘Rehabilitation hospitalization’ group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.
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Humanos , Actividades Cotidianas , Afasia , Cognición , Estudios de Cohortes , Depresión , Diagnóstico , Vivienda , Corea (Geográfico) , Tamizaje Masivo , Alta del Paciente , Psicología , Calidad de Vida , Rehabilitación , Accidente Cerebrovascular , CaminataRESUMEN