Meso-scale Discovery Assay Detects the Changes of Plasma Cytokine Levels in Mice after Low or High LET Ionizing Irradiation / 生物医学与环境科学（英文）

Objective@#To obtain precise data on the changes in the levels of 29 cytokines in mice after high or low linear energy transfer (LET) irradiation and to develop an accurate model of radiation exposure based on the cytokine levels after irradiation.@*Methods@#Plasma samples harvested from mice at different time points after carbon-ion or X-ray irradiation were analyzed using meso-scale discovery (MSD), a high-throughput and sensitive electrochemiluminescence measurement technique. Dose estimation equations were set up using multiple linear regression analysis.@*Results@#The relative levels of IL-6 at 1 h, IL-5 and IL-6 at 24 h, and IL-5, IL-6 and IL-15 at 7 d after irradiation with two intensities increased dose-dependently. The minimum measured levels of IL-5, IL-6 and IL-15 were up to 4.0076 pg/mL, 16.4538 pg/mL and 0.4150 pg/mL, respectively. In addition, dose estimation models were established and verified.@*Conclusions@#The MSD assay can provide more accurate data regarding the changes in the levels of the cytokines IL-5, IL-6 and IL-15. These cytokines could meet the essential criteria for radiosensitive biomarkers and can be used as radiation indicators. Our prediction models can conveniently and accurately estimate the exposure dose in irradiated organism.

Garanticemos la calidad de las muestras respiratorias para diagnosticar COVID-19 / Let's guarantee the quality of respiratory samples to diagnose COVID-19

Resumen Este artículo y video disponibles en el OJS de la Revista describe los procedimientos para la recolección de hisopos respiratorios que garantizan la bioseguridad y el diagnóstico de COVID-19 en adultos y niños.

Abstract This article and video describes the procedures for the collection of respiratory swabs that guarantee biosecurity and the diagnosis of COVID-19 in adults and children.

Study of clustered damage in DNA after proton irradiation based on density-based spatial clustering of applications with noise algorithm / 生物医学工程学杂志

The deoxyribonucleic acid (DNA) molecule damage simulations with an atom level geometric model use the traversal algorithm that has the disadvantages of quite time-consuming, slow convergence and high-performance computer requirement. Therefore, this work presents a density-based spatial clustering of applications with noise (DBSCAN) clustering algorithm based on the spatial distributions of energy depositions and hydroxyl radicals (·OH). The algorithm with probability and statistics can quickly get the DNA strand break yields and help to study the variation pattern of the clustered DNA damage. Firstly, we simulated the transportation of protons and secondary particles through the nucleus, as well as the ionization and excitation of water molecules by using Geant4-DNA that is the Monte Carlo simulation toolkit for radiobiology, and got the distributions of energy depositions and hydroxyl radicals. Then we used the damage probability functions to get the spatial distribution dataset of DNA damage points in a simplified geometric model. The DBSCAN clustering algorithm based on damage points density was used to determine the single-strand break (SSB) yield and double-strand break (DSB) yield. Finally, we analyzed the DNA strand break yield variation trend with particle linear energy transfer (LET) and summarized the variation pattern of damage clusters. The simulation results show that the new algorithm has a faster simulation speed than the traversal algorithm and a good precision result. The simulation results have consistency when compared to other experiments and simulations. This work achieves more precise information on clustered DNA damage induced by proton radiation at the molecular level with high speed, so that it provides an essential and powerful research method for the study of radiation biological damage mechanism.

Learning and Oxytocin / 생물치료정신의학

Neuropeptide oxytocin serves as a neuromodulator in the brain and as a hormone in the body. Oxytocin as a hypothalamic hormone causes contractions during the second and third stages of labor and lets milk come out during breast feeding. As a neuromodulator, oxytocin that influences social affiliative behavior plays an important role in social cognition and emotional learning. Recent studies showed that oxytocin affects basic fear learning and fear extinction precess in a social context. Furthermore, oxytocin has anxiolytic and stress-dampening effects when combined with social support, i.e. a safety stimuli. Also, oxytocin enhances basic emotional learning precesses of both acquisition and extinction of an emotional content while simultaneously decreasing pain experiences. Oxytocin has involvement in attachment, and is shown to improve positive affective behavior in romantic relations. Social buffering effects that social touch and emotional and physical intimacy play crucial roles in coping with negative effects are assumed to be mediated through brain oxytocin mechanisms. Researches indicate that oxytocin significantly inhibits hypothalamic-pituitary-adrenal axis activity in response to stress, and consequently reduces cortisol levels. Conversely, exposure to stress triggers the release of intrahypothalamic and plasma oxytocin. These results suggest that oxytocin may be a new pavement in treating post-traumatic stress disorder and depression.

Let Clinicians Classify Emergency Patients

No abstract available.

Design of a combined cartilage graft crusher, morselizer and holder for use in rhinoplasty

A combined cartilage holder and crusher is described that allows the surgeon to hold, crush, morselize, and suture a single piece or stack of cartilage graft without letting it slip. The customized slit-shaped jaws allow adequate room for the suture needle, while the serrated surfaces hold the cartilage firmly. The use of this instrument is advocated primarily in rhinoplasty for manipulating and suturing a small cartilage graft or a stack of grafts. The use of this instrument may be extended to aesthetic or reconstructive cases where cartilage grafts need to be sutured or shaped, as in eyelid, ear, and nipple reconstruction.

Should Let Them Go? Study on the Emergency Department Discharge of Patients Who Attempted Suicide

OBJECTIVE: The purpose of this study was to analyze the characteristics and factors of voluntary discharged patients after suicide attempt and analyze the effectiveness of follow-up measures. METHODS: Total 504 adult patients aged 14 years and over, who visited a local emergency medical center from September 1, 2013 to December 31, 2015 were enrolled and retrospectively reviewed. We analyzed the relationship with voluntary discharge group (VDG) among basic characteristics, suicidal attempt variables, outcome variables related to suicide attempts, and treatment related variables comparing with normal discharge group (NDG). RESULTS: Of the total 504 suicide attempts, three hundred eleven (61.7%) patients were VDG and 193 (38.2%) were NDG. The proportion of patients who completed the community service linkage were 18.7% (36/193) in NDG, compared with 7.7% (24/311) in VDG (p < 0.05). In addition, the ratio of the patients who visited psychiatric outpatient department in NDG were 57.0% (110/193), more than four times as likely as 14.5% (45/311) in VDG (p < 0.05). CONCLUSION: Over sixty percent of suicide attempters discharged against medical advice. Further various aspects of national supportive measures including strengthening case management service should be considered.

What Is the Most Effective Eccentric Stretching Position in Lateral Elbow Tendinopathy?

BACKGROUND: A variety of treatment options suggest that the optimal treatment strategy for lateral elbow tendinopathy (LET) is not known, and further research is needed to discover the most effective treatment for LET. The purpose of the present study was to verify the most effective position of eccentric stretching for the extensor carpi radialis brevis (ECRB) in vivo using ultrasonic shear wave elastography. METHODS: A total of 20 healthy males participated in this study. Resting position was defined as 90° elbow flexion and neutral position of the forearm and wrist. Elongation of the ECRB was measured for four stretching maneuvers (forearm supination/pronation and wrist extension/flexion) at two elbow angles (90° flexion and full extension). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the eight aforementioned stretching maneuverangle combinations. RESULTS: The shear elastic modulus was the highest in elbow extension, forearm pronation, and wrist flexion. The shear elastic moduli of wrist flexion with any forearm and elbow position were significantly higher than the resting position. There was no significant difference associated with elbow and forearm positions except for elbow extension, forearm pronation, and wrist flexion positions. CONCLUSIONS: This study determined that elbow extension, forearm pronation, and wrist flexion was the most effective eccentric stretching for the ECRB in vivo.

Let us not discard a preexisting epidural catheter for intrapartum cesarean section yet! / 대한마취과학회지

No abstract available.

Pilot Study Results of a Longitudinal Integrated Clerkship in a Single Institution / 의학교육논단

The longitudinal integrated clerkship is an innovative approach in medical education that emphasizes continuity as a key principle to provide student-centered experiences and learning. Seoul National University College of Medicine decided to adapt longitudinal integrated clerkships to the new curriculum beginning in 2018, and therefore conducted pilot studies in 2016 and 2017. This study aimed to analyze the program evaluation results of the two pilot programs and discuss issues related to the successful implementation of longitudinal integrated clerkships in Korea. We conducted a focus group interview with nine students who participated in the 2016 pilot program and 13 students who participated in the 2017 pilot program. We also conducted a focus group interview with 11 faculty members who either participated in the pilot program or will participate in the main program. From the 2016 experience, we found that it is not appropriate to assign each patient to a single student and let the students contact their patients personally for feasibility and safety reasons. In the 2017 pilot program, we assigned each patient to a group of students, which made it more feasible for the students to follow-up with their patients. The students were satisfied with their new experience of longitudinal patient follow-up and regular meetings in the pilot program. Faculty emphasized the importance of establishing the course objectives and holding an orientation for the students and the faculty. Further study is planned to evaluate the early outcomes of the main longitudinal integrated clerkship.

Radioprotective effects of delphinidin on normal human lung cells against proton beam exposure

BACKGROUND/OBJECTIVES: Exposure of the normal lung tissue around the cancerous tumor during radiotherapy causes serious side effects such as pneumonitis and pulmonary fibrosis. Radioprotectors used during cancer radiotherapy could protect the patient from side effects induced by radiation injury of the normal tissue. Delphinidin has strong antioxidant properties, and it works as the driving force of a radioprotective effect by scavenging radiation-induced reactive oxygen species (ROS). However, no studies have been conducted on the radioprotective effect of delphinidin against high linear energy transfer radiation. Therefore, this study was undertaken to evaluate the radioprotective effects of delphinidin on human lung cells against a proton beam. MATERIALS/METHODS: Normal human lung cells (HEL 299 cells) were used for in vitro experiments. The 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay assessed the cytotoxicity of delphinidin and cell viability. The expression of radiation induced cellular ROS was measured by the 2′-7′-dicholordihydrofluorescein diacetate assay. Superoxide dismutase activity assay and catalase activity assay were used for evaluating the activity of corresponding enzymes. In addition, radioprotective effects on DNA damage-induced cellular apoptosis were evaluated by Western blot assay. RESULTS: Experimental analysis, including cell survival assay, MTT assay, and Western blot assay, revealed the radioprotective effects of delphinidin. These include restoring the activities of antioxidant enzymes of damaged cells, increase in the levels of pro-survival protein, and decrease of pro-apoptosis proteins. The results from different experiments were compatible with each to provide a substantial conclusion. CONCLUSION: Low concentration (2.5 µM/mL) of delphinidin administration prior to radiation exposure was radioprotective against a low dose of proton beam exposure. Hence, delphinidin is a promising shielding agent against radiation, protecting the normal tissues around a cancerous tumor, which are unintentionally exposed to low doses of radiation during proton therapy.

The Development of the Mission · Vision · Core Values for Korean NeuroPsychiatric Association / 신경정신의학

Awareness of public mental health has increased due to drastic changes in society, and issues concerning the rights of mentally ill patients have emerged. The Korean NeuroPsychiatric Association (KNPA) has examined the current environment and proposed directions for improvement of this field. As the step for the implementation of the development of the mission · vision · core values for KNPA, KNPA have gone on the effort to improve public mental health letting people realize of the work that KNPA have carried out and help members work together. The committee of special mission of KNPA began in 2016 and held its first meeting on March 25 with professional consultants. They researched and collected information, carried out interviews, surveys, analyzed various opinions, and examined information and materials throughout 7 meetings. The special members of KNPA submitted agendas to the board of directors on September 9th, and the provisional board committee debated and decided the final agendas on September 24th. They announced the mission · vision · core values for KNPA on October 28th at the great autumn congregation held in Kimdaejung Convention Center in Kwangju. The event has proved that all members of KNPA have cooperated for the rights and interest of the committee, and will lead the public mental health of our society. This will provide the basis for the better life of our society.

Legislative Issues in Disclosing Financial Conflicts of Interest to Participants in Biomedical Research: Effectiveness and Methodology

This research focuses on the analysis regarding disclosure of financial conflicts of interest (FCOI) after Gelsinger v. University of Pennsylvania (Penn). The main legal issue was that the participants did not have enough opportunity to make an autonomous decision about participating in the research because he was not informed about the researchers' and the institution's substantial FCOI. The disclosure system was adopted by the Code of Federal Regulations. Under the regulation, researchers and institutions need to report FCOI over $5,000 to the institution, and the internal review boards have to report to the federal authority if needed. In case of human research, the disclosure to Food and Drug Administration is mandatory. FCOI disclosure system would help participants to make an autonomous decision, and increase trust to the research process and researchers. Moreover, the system would let researchers keep fiduciary duty while (possibly) lowering legal liability in case of a lawsuit. There were discussions about the disclosure methodology in the United States. However, there have not been a lot of discussions in Korea even after the “Humidifier Disinfectant” case. Therefore, new legislations need to be considered. First, the system requires disclosure funded by not only government but also private institutions. Second, like California Supreme Court, the subject would be reviewed under the reasonable person standard by participants, including patents, equity, and stock. Third, the disclosure needs to include simple or brief explanation to the FCOI to be better understood by the participants. Fourth, the disclosure should be in the informed consent process.

An Empirical Study on Factor Associated with Mood Disorders in Elderly: Focusing on the Influence of Community Characteristics / 보건행정학회지

BACKGROUND: The mental problems of the elderly are at issue as a serious social phenomenon. The purpose of this study is to identify risk factors affecting the mood disorders of the elderly. METHODS: The subjects were 1,779,236 aged ≥65 and participated in health screening. Dependent variable was mood disorders. Independent variables were consisted of community level (regional deprivation index and healthcare resources) and individual level (sex, age, insurance type, disability, smoking, alcohol, physical activity, body mass index, and healthcare utilization). Multilevel logistic regression was performed. RESULTS: At the individual level, women, employed insured, severely disabled people, heavy alcohol drinkers, high-intensity physical activity, body mass index, and patients who had chronic disease and severe disease were significantly associated with mood disorders. As the age has increased, it has let increase of mood disorders. At the community level, as the regional deprivation index has increased by 1, mood disorders has been increased by 1.005 times. The intra-class coefficient was 7.04%. CONCLUSION: We found individual and community level factors are associated with mood disorders. Systematic approach is essential to reduce mood disorders.

Osteoblasts Are the Centerpiece of the Metastatic Bone Microenvironment

The tumor microenvironment is comprised of diverse stromal cell populations in addition to tumor cells. Increasing evidence now clearly supports the role of microenvironment stromal cells in tumor progression and metastasis, yet the regulatory mechanisms and interactions among tumor and stromal cells remain to be elucidated. Bone metastasis is the major problem in many types of human malignancies including prostate, breast and lung cancers, and the biological basis of bone metastasis let alone curative approaches are largely undetermined. Among the many types of stromal cells in bone, osteoblasts are shown to be an important player. In this regard, osteoblasts are a key target cell type in the development of bone metastasis, but there are currently no drugs or therapeutic approaches are available that specifically target osteoblasts. This review paper summarizes the current knowledge on osteoblasts in the metastatic tumor microenvironment, aiming to provide clues and directions for future research endeavor.

Delayed Diagnosis of Small Cell Lung Cancer in a Patient with Allergic Bronchopulmonary Aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder induced by Aspergillus fumigatus that occurs generally in patients with underlying chronic airway disorders. However, the development of ABPA associated with lung malignancy remains unknown. An 80-year-old woman was admitted for evaluation of chronic cough. Her radiologic finding was a mass like opacity with mucoid impaction, showing finger-in-glove sign, one of the typical radiologic findings for ABPA. In addition, laboratory tests revealed that her data satisfied the diagnostic criteria for ABPA. Interestingly, final pathologic examination showed that the mass lesion was small cell lung cancer. Here, we describe a case of delayed diagnosis of small cell lung cancer with ABPA, suggesting that a possibility of accompanying lung malignancy such as small cell lung cancer should be considered in patients with ABPA. This case let us realize the importance of clinical suspicion that different entities of diseases can be occurred simultaneously for the correct diagnosis without delay.

Cervical Sympathetic Chain Schwannoma Mimicking Carotid Body Tumor / 대한이비인후과학회지

Schwannoma arising from cervical sympathetic chain is relatively uncommon and can be occasionally misdiagnosed as carotid body tumor. On MR images, schwannoma shows generally hypointense features on the T1-weighted images and hyperintense features on the T2-weighted images. Occasionally, however, contrast administration, which lets schwannoma show marked enhancement, may make it difficult to differentiate schwannoma from carotid body tumor. A 41-year-old woman presented a neck mass on the left. MR images of the neck and carotid angiography revealed a well-enhancing ovoid tumor, which separated the internal carptod arteries from the external carotid arteries at the level of carotid bifurcation. Complete tumor resection was performed and histopathology findings confirmed a schwannoma originating from the sympathetic chain. Postoperatively, miosis and facial anhydrosis of the left side were noted without ptosis, enophthalmos or other neurologic deficits. We report this case with a review of the literatures.

Perception of interprofessional conflicts and interprofessional education by doctors and nurses / 한국의학교육

PURPOSE: This study aimed to collect information that is needed to develop interprofessional education curricula by examining the current status of interprofessional conflicts and the demand for interprofessional education. METHODS: A total of 95 doctors and 92 nurses in three university hospitals in Seoul responded to a survey that comprised questions on past experience with interprofessional conflicts, the causes and solutions of such conflicts, past experience with interprofessional education, and the demand for interprofessional education. RESULTS: We found that 86% of doctors and 62.6% of nurses had no interprofessional education experience. Most of them learned about the work of other health professions naturally through work experience, and many had experienced at least one interprofessional conflict. For doctors, the most popular method of resolving interprofessional conflicts was to let the event pass; for nurses, it was to inform the department head. Further, 41.5% of doctors and 56.7% of nurses expressed no knowledge of an official system for resolving interprofessional conflicts within the hospital, and 62.8% of doctors and 78.3% of nurses stated that they would participate in interprofessional education if the opportunity arose. CONCLUSION: In Korean hospital organizations, many doctors and nurses have experienced conflicts with other health professionals. By developing an appropriate curriculum and educational training system, the opportunities for health professionals to receive interprofessional education should expand.

The Lived Experience of Japanese Marriage-Immigrants' Caring for Parents-in-law with Chronic Illness / 한국간호교육학회지

PURPOSE: The study was done to explore lived experience of Japanese women taking care of chronically ill parents-in-law at home under the Korean family culture emphasizing filial piety. METHOD: van Manen's Hermeneutic Phenomenology research method was applied to conduct in-depth analysis on the meaning and nature of those experiences. This method derives the universal and fundamental aspect of human being. RESULTS: There were 8 essential themes derived from the Japanese marriage-immigrants' experiences taking care of parents-in-law with chronic diseases as followings: 'stuck in a situation in which I am obligated to take care of the parent-in-law', 'hard to be the only person responsible to take care of the parent-in-law', 'unaccustomed to the Korean filial duty culture', 'the adverse effect of Korean-Japan history on taking care of the parent-in-law', 'refusing to let the taking care of the parent-in-law to be a shackle of my life', 'starting to be willing to take care of the parent-in-law', 'following through with my own way of taking care of the parent-in-law without being swayed by what others say', 'growing in the process of taking care of the parent-in-law'. CONCLUSION: The study results broadened ground to understand the experiences taking care of chronically ill parent-in-law from Japanese marriage-immigrants' social and cultural perspectives.