Prognostic Value of Baseline Neutrophilto-Lymphocyte Ratio Combined With Anemia in Patients With ST-Segment Elevation Myocardial Infarction: A Nationwide Prospective Cohort Study

Objective@#Data pertaining to the prognostic value of the combination of high neutrophilto-lymphocyte ratio (NLR) and anemia on admission in patients with ST-segment elevation myocardial infarction (STEMI) are limited. The objective of this study was to investigate the clinical value of baseline NLR in combination with anemia in predicting clinical outcomes after STEMI. @*Methods@#A total of 5,194 consecutive patients with STEMI within 12 hours of symptom onset from the Korea Acute Myocardial Infarction Registry-National Institute of Health database between 2011 and 2015 were categorized into 4 groups according to their NLR and hemoglobin levels: low NLR (<4) without anemia (n=2,722; reference group); high NLR (≥4) without anemia (n=1,527); low NLR with anemia (n=508); and high NLR with anemia (n=437). The co-primary outcomes were 180-day and 3-year all-cause mortality. @*Results@#Mortality rates significantly increased at the 3-year follow-up across the groups (3.3% vs. 5.4% vs. 16.5% vs. 21.7% for 180-day mortality and 5.3% vs. 9.0% vs. 23.8% vs. 33.4% for 3-year mortality; all p-trends <0.001). After adjusting for baseline covariates, the combination of high NLR and anemia was a significant predictor of 180-day mortality after STEMI with low NLR and no anemia as the reference (adjusted hazard ratio, 2.16; 95% confidence interval, 1.58–2.95; p<0.001). Similar findings were observed for the 3-year mortality. @*Conclusions@#This nationwide prospective cohort study showed that the combination of high NLR (≥4) and anemia is a strong predictor of all-cause mortality after STEMI.

Reimbursement of Digital Therapeutics: Future Perspectives in Korea

Digital health is rapidly growing worldwide and its area is expanding from wellness to treatment due to digital therapeutics (DTx). This study compared DTx in the Korean context with other countries to better understand its political and practical implications. DTx is generally the same internationally, often categorized as software as a medical device. It provides evidence-based therapeutic interventions for medical disabilities and diseases.Abroad, DTx support entailed state subsidies and fundraising and national health insurance coverage. In the case of national health insurance coverage, most cases were applied to mental diseases. Moreover, in Japan, DTx related to hypertension will possibly be under discussion for national health insurance coverage in 2022. In overseas countries, coverage was decided only when the clinical effects were equivalent to those provided by existing technology, and in the UK, real usage data for DTx and associated evaluations were reflected by national health coverage determination. Prices were either determined through closed negotiations with health insurance operating agencies and manufacturers or established based on existing technology. Concerning the current situation, DTx dealing with various diseases including hypertension are expected to be developed near in the future, and the demand for use and compensation will likely increase. Therefore, it is urgent to define and prepare for DTx, relevant support systems, and health insurance coverage listings. Several support systems must be considered, including government subsidies, science/technology funds, and health insurance.

Effect of Educational Nurse Practitioners at Comprehensive Nursing Care Service Units / 임상간호연구

Purpose@#This study aimed to investigate the effect of educational nurse practitioners at comprehensive nursing care service units by comparing the educational satisfaction of general nurses and the occupational stress of preceptor nurses before and after education by educational nurse practitioners. @*Methods@#Participants were 71 general nurses and 71 preceptor nurses working at comprehensive nursing care service units of G University hospital in I City. The level of educational satisfaction of general nurses and occupational stress of preceptor nurses were measured and compared. The differences in educational satisfaction and occupational stress before and after the education program were verified by paired t-test and one-way ANOVA using SPSS/WIN 27.0 statistical program. Differences before and after the education program according to the general characteristics were analyzed with repeated measure analysis of variance after Sapiro-Wilks normality test, and post-hoc analysis was conducted using Scheffé test. @*Results@#It was inferred that there was a significant difference (t=-9.32, p <.001) in the educational satisfaction of general nurses, with an average of 3.72±0.77 before the education and 4.47±0.60 after the education. However, there was no significant difference in occupational stress in the preceptor nurses. @*Conclusion@#It could be concluded that introduction of educational nurse practitioners at comprehensive nursing care service units has a positive effect on the educational satisfaction of general nurses. This result will serve as basic data to implement educational nurse practitioners for general nurses in all medical institutions as well as comprehensive nursing care service units.

Effect of Educational Nurse Practitioners at Comprehensive Nursing Care Service Units / 임상간호연구

Purpose@#This study aimed to investigate the effect of educational nurse practitioners at comprehensive nursing care service units by comparing the educational satisfaction of general nurses and the occupational stress of preceptor nurses before and after education by educational nurse practitioners. @*Methods@#Participants were 71 general nurses and 71 preceptor nurses working at comprehensive nursing care service units of G University hospital in I City. The level of educational satisfaction of general nurses and occupational stress of preceptor nurses were measured and compared. The differences in educational satisfaction and occupational stress before and after the education program were verified by paired t-test and one-way ANOVA using SPSS/WIN 27.0 statistical program. Differences before and after the education program according to the general characteristics were analyzed with repeated measure analysis of variance after Sapiro-Wilks normality test, and post-hoc analysis was conducted using Scheffé test. @*Results@#It was inferred that there was a significant difference (t=-9.32, p <.001) in the educational satisfaction of general nurses, with an average of 3.72±0.77 before the education and 4.47±0.60 after the education. However, there was no significant difference in occupational stress in the preceptor nurses. @*Conclusion@#It could be concluded that introduction of educational nurse practitioners at comprehensive nursing care service units has a positive effect on the educational satisfaction of general nurses. This result will serve as basic data to implement educational nurse practitioners for general nurses in all medical institutions as well as comprehensive nursing care service units.

Relationships between Self-Esteem, Emotional Intelligence, and Mindfulness of Employees in Large Corporations / 한국직업건강간호학회지

Purpose@#This study aimed to identify influencing factors on the stress of employees in large corporations by examining relationships between self-esteem, emotional intelligence, and mindfulness. @*Methods@#A hundred and sixty four employees from large corporations completed self-reporting questionnaires during November and December, 2019. The collected data were analyzed with SPSS/WIN 22.0 using descriptive statistics, the t-test, ANOVA, correlation, and multiple regression analysis. @*Results@#The scores were 2.96±0.40 for “self-esteem”, 3.56±0.61 for “emotional intelligence”, 4.01±0.04 for “mindfulness”, and 2.21±0.79 for “stress response”. A regression analysis identifying factors affecting the stress response of employees in large corporations showed that “mindfulness” was the most significant factor (β=-.58, p<.001), followed by “emotional intelligence” (β=-.21, p=.005) and “self-esteem” (β=-.16, p=.009). The explanatory power of these variables for the stress response of employees in large corporations was 48%. @*Conclusion@#Our findings suggest that self-esteem, emotional intelligence, and mindfulness are significantly related to employees’ stress response in large corporations. Therefore, stress response management programs should be developed to improve self-esteem, emotional intelligence, and mindfulness.

Effects of different wavelengths of blue light on human retinal pigment epithelial cells / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effects of different wavelength of blue light on human retinal pigment epithelial(RPE)cells. <p>METHODS: ARPE-19 cells cultured <i>in vitro</i> were randomly divided into four groups, which were control group, 447nm blue light group, 456nm blue light group and 468nm blue light group. The cells in control group were cultured under normal conditions whereas the cells in blue light group were irradiated with different wavelengths of OLED blue light with the illumination intensity of 200Lux for 72h. Live/Dead staining assay, CCK-8 assay and real-time PCR were performed to compare the effects of different wavelengths of blue light on the morphology, cell viability, proliferation capacity, mRNA expression level of visual cycle biomarkers and inflammatory biomarkers of ARPE-19 cells, respectively.<p>RESULTS: After blue light irradiation, the abnormal morphology and the decrease of cell confluence of ARPE-19 cells were observed. Furthermore, with the decrease in the wavelength of blue light, the inhibition effect of blue light on RPE proliferation was enhanced, and the mRNA expression of the proliferation marker Ki-67 and visual cycle biomarkers LRAT, CRALBP, RDH and IRBP decreased. In addition, the mRNA expression levels of inflammatory factors MCP-1 and IL-6 in RPE cells were up-regulated with the decrease in the wavelength of blue light.<p>CONCLUSION: Our data demonstrated that blue light in different wavelengths exerted detrimental effects on RPE cells. The shorter the wavelength of blue light was, the more severe damage it caused on the RPE cells.

Recent advances in the discovery of dengue virus inhibitors / 药学学报

Dengue fever is one of the most important vector-borne human diseases caused by mosquito vector Aedes aegypti and Aedes albopictus. Dengue virus can cause dengue fever, dengue hemorrhagic fever and dengue shock syndrome. There are no approved drugs for the treatment of dengue disease so far. In this paper, combined with the latest progress in the research of anti-dengue virus, the new progress in the research of anti-dengue virus drugs was reviewed from the aspects of protease inhibitors, virus polymerase inhibitors, entry inhibitors, virus replication-related host factor inhibitors, capsid protein inhibitors and nucleic acid inhibitors.

Progress on IFV drug targets and small molecule inhibitors / 药学学报

The outbreak of the influenza viruses (IFV) caused significant harm to our health and life. Human infections caused by pathogenic avian influenza virus (AIV) have continually brought great panic and death threats to people all over the world. With the in-depth study of the biological characteristics of influenza viruses and the rapid development of drug discovery screening technology, a new generation of anti-influenza drug targets and their inhibitors have been continuously discovered, providing more options for the treatment of influenza. From the point of view of medicinal chemistry, this review summarizes and discusses current endeavours towards the discovery and development of novel inhibitors and also provides examples illustrating new methodologies that contribute to the identification of novel anti-influenza drugs.

Quercetin induces cell death in cervical cancer by reducing O-GlcNAcylation of adenosine monophosphate-activated protein kinase / 대한해부학회지

Hyper-O-GlcNAcylation is a general feature of cancer which contributes to various cancer phenotypes, including cell proliferation and cell growth. Quercetin, a naturally occurring dietary flavonoid, has been reported to reduce the proliferation and growth of cancer. Several reports of the anticancer effect of quercetin have been published, but there is no study regarding its effect on O-GlcNAcylation. The aim of this study was to investigate the anticancer effect of quercetin on HeLa cells and compare this with its effect on HaCaT cells. Cell viability and cell death were determined by MTT and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labelling assays. O-GlcNAcylation of AMP-activated protein kinase (AMPK) was examined by succinylated wheat germ agglutinin pulldown and immunoprecipitation. Immunofluorescence staining was used to detect the immunoreactivitiy of O-linked N-acetylglucosamine transferase (OGT) and sterol regulatory element binding protein 1 (SREBP-1). Quercetin decreased cell proliferation and induced cell death, but its effect on HaCaT cells was lower than that on HeLa cells. O-GlcNAcylation level was higher in HeLa cells than in HaCaT cells. Quercetin decreased the expression of global O-GlcNAcylation and increased AMPK activation by reducing the O-GlcNAcylation of AMPK. AMPK activation due to reduced O-GlcNAcylation of AMPK was confirmed by treatment with 6-diazo-5-oxo-L-norleucine. Our results also demonstrated that quercetin regulated SREBP-1 and its transcriptional targets. Furthermore, immunofluorescence staining showed that quercetin treatment decreased the immunoreactivities of OGT and SREBP-1 in HeLa cells. Our findings demonstrate that quercetin exhibited its anticancer effect by decreasing the O-GlcNAcylation of AMPK. Further studies are needed to explore how quercetin regulates O-GlcNAcylation in cancer.

Influence of beverage type and ingestion time on tooth corrosion / 대한치과재료학회지

This study was conducted to analyze the effects of beverages on tooth corrosion by selecting drinks that are enjoyed by modern people. Drinks were selected for carbonated beverages (Coca Cola), energy drinks (Red Bull), orange juice, beer (Hite) and water (Evian). Bovine tooth was immersed for 1 hour, 24 hours and 48 hours. The root mean square (RMS) values were obtained by scanning the bovine tooth at pre-immersion and immersion time after impression making. Two-way ANOVA, one-way ANOVA, and Tukey-test were used to compare differences between groups (α=0.05). The RMS value tended to increase with longer immersion times in all beverages, and there was a significant difference (p < 0.05) between before immersion-1hr and before immersion-48 hr. The mean of RMS according to the type of beverage was significantly different and there was a significant difference according to the change of immersion time (p < 0.05). In order to prevent tooth corrosion, it is necessary to change the method of ingestion or to reduce the time of ingestion.

Elderly Patient Trends in a Chronic Mental Hospital and Accompanying Medical Diseases

OBJECTIVE: It investigated the tendency of the increase of elderly patients in a psychiatric hospital. In this regard, it examined whether the number of patients with outpatient consultant, discharge, medical diseases, and neurocognitive disorder increased or not. METHODS: It retrospectively reviewed inpatient medical records for the years 2008, 2011, 2014, 2017. To investigate the changes of elderly patients admitted to psychiatry, it examined the changes of patients who are older than 50 or 60 years in addition to the people who are older than 65 years. It analyzed diagnosis, discharge, medical diseases, and outpatient consultant of the three groups respectively. RESULTS: It confirmed that the number of elderly patients who are older than 50, 60, and 65 years has increased in mental hospital for 10 years. There was a significant increase in the number of neurocognitive disorder patients, the ratio of consultant outpatient, and the mean number of outpatient consultant. Diabetes increased in all three groups. Especially it has significantly increased for patients who are older than 50 and 60 years. In the case of patients discharged due to transfer, the number of patients increased in all three groups but it was statistically significant for the patients who are older than 50 years. CONCLUSION: The study shows that the number of elderly patients increased with the trend of aging society. In relation to this, the rate of outpatient consultant and discharge, including diabetic and dementia patients, also increased. Therefore, if the mental health department provides a system to manage the elderly ward or nursing ward to respond to the increase of elderly patients, or to manage the accompanying chronic diseases such as diabetes and its complications, it could solve the inconvenience of patients due to the consultation outside a hospital or discharge.

Huge pheochromocytoma presented with paraaortic lymph node and spine metastases / 영남의대학술지

Approximately 10–15% of pheochromocytomas are malignant. There are insufficient histologic criteria for the diagnosis of malignant pheochromocytoma. Thus, the term malignant pheochromocytoma is restricted to tumors with local invasion or distant metastases. We experienced a case of malignant pheochromocytoma recurred with spinal metastasis 4 years after the surgery for huge benign pheochromocytoma. A 68-year-old female was admitted for trunk and back pain. The patient had a history of surgery 4 years ago for a 10.0×9.5×7.5 cm sized benign pheochromocytoma at the left adrenal gland. A thoracolumbar magnetic resonance imaging showed a tumor in the 7th thoracic vertebral body and a 24-hour urinary norepinephrine increased, suggesting metastatic recurrence of malignant pheochromocytoma. After metastasectomy in the 7th thoracic vertebral body, urine catecholamine was normalized and pain also disappeared. However, a metastatic lesion was found in the paraaortic area on a follow-up abdominal computed tomography scan and an additional metastasectomy was performed. The pathology confirmed the diagnosis of metastatic pheochromocytoma in the paraaortic lymph nodes. She is supposed to be treated with adjuvant iodine 131-meta-iodobenzylguanidine therapy. In our experience, a close follow-up should be considered in patients who had a huge benign pheochromocytoma due to the possibility of malignant metastases.

Combining levodopa and virtual reality-based therapy for rehabilitation of the upper limb after acute stroke: pilot study Part II

<p><b>INTRODUCTION</b>This study aimed to evaluate the safety and efficacy of a combination of levodopa and virtual reality (VR)-based therapy for the enhancement of upper limb recovery following acute stroke.</p><p><b>METHODS</b>This was a pilot single-blinded case series of acute stroke patients with upper extremity hemiparesis. Patients were randomised to standard care with concomitant administration of either levodopa alone (control group) or combination therapy consisting of VR-based motivational visuomotor feedback training with levodopa neuromodulation (VR group). Main clinical outcome measures were the Fugl-Meyer Upper Extremity (FM-UE) assessment and Action Research Arm Test (ARAT). Kinematic measurements of affected upper limb movement were evaluated as a secondary measure of improvement.</p><p><b>RESULTS</b>Of 42 patients screened, four patients were enrolled in each of the two groups. Two patients dropped out from the control group during the trial. Patients receiving combination therapy had clinically significant improvements in FM-UE assessment scores of 16.5 points compared to a 3.0-point improvement among control patients. Similarly, ARAT scores of VR group patients improved by 15.3 points compared to a 10.0-point improvement in the control group. Corresponding improvements were noted in kinematic measures, including hand-path ratio, demonstrating that the quality of upper limb movement improved in the VR group.</p><p><b>CONCLUSION</b>Our results suggest that VR-based therapy and pharmacotherapy may be combined for acute stroke rehabilitation. Bedside acquisition of kinematic measurements allows accurate assessment of the quality of limb movement, offering a sensitive clinical tool for quantifying motor recovery during the rehabilitation process after acute stroke.</p>

Huge pheochromocytoma presented with paraaortic lymph node and spine metastases / 영남의대학술지

Approximately 10–15% of pheochromocytomas are malignant. There are insufficient histologic criteria for the diagnosis of malignant pheochromocytoma. Thus, the term malignant pheochromocytoma is restricted to tumors with local invasion or distant metastases. We experienced a case of malignant pheochromocytoma recurred with spinal metastasis 4 years after the surgery for huge benign pheochromocytoma. A 68-year-old female was admitted for trunk and back pain. The patient had a history of surgery 4 years ago for a 10.0×9.5×7.5 cm sized benign pheochromocytoma at the left adrenal gland. A thoracolumbar magnetic resonance imaging showed a tumor in the 7th thoracic vertebral body and a 24-hour urinary norepinephrine increased, suggesting metastatic recurrence of malignant pheochromocytoma. After metastasectomy in the 7th thoracic vertebral body, urine catecholamine was normalized and pain also disappeared. However, a metastatic lesion was found in the paraaortic area on a follow-up abdominal computed tomography scan and an additional metastasectomy was performed. The pathology confirmed the diagnosis of metastatic pheochromocytoma in the paraaortic lymph nodes. She is supposed to be treated with adjuvant iodine 131-meta-iodobenzylguanidine therapy. In our experience, a close follow-up should be considered in patients who had a huge benign pheochromocytoma due to the possibility of malignant metastases.

Diagnostic Usefulness of Korean Standard on Heavy Drinking for the DSM-5 Alcohol Use Disorder

BACKGROUND: This research investigated the usefulness of heavy drinking standards of ‘guidelines for moderate alcohol drinking amount for Koreans’ for diagnosis of Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) alcohol use disorder. METHODS: This retrospective study was conducted with 976 adults who visited an health screening center in Daejeon for health check-up in 2015. Daily drinking amount, drinking frequency per week, and weekly drinking amount were investigated. Using the heavy drinking criteria of Korean guideline, participants were grouped by age and gender and classified as normal or heavy drinkers. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Positive likelihood ratio (LR+), Negative likelihood ratio (LR-), odds ratio (OR) and Youden's Index of heavy drinking according to Korean guideline for diagnosis of DSM-5 alcohol use disorder were calculated. RESULTS: The Area under the receiver operating characteristic (ROC) curve of a model screening DSM-5 alcohol use disorder by weekly drinking amount were 0.812 in males up to age 65 years and 0.931 in males over age 65 years and females respectively. The sensitivity, specificity, PPV and NPV of Korean guideline heavy drinking group for diagnosis of DSM-5 alcohol use disorder were 61.0%, 89.7%, 67.0%, and 87.05% respectively. The LR+, LR-, OR and Youden's Index of those were 5.917 (4.704-7.435), 0.434 (0.379-0.497), 13.623 (9.607-19.317), and 0.507 respectively. CONCLUSIONS: This research shows the Korean heavy drinking standard is useful for diagnosis of DSM-5 alcohol use disorder in Korean people.

Usefulness of Heavy Drinking and Binge Drinking for the Diagnosis of Alcohol Use Disorder / 가정의학회지

BACKGROUND: This research investigated the sensitivity and specificity of heavy and binge drinking for screening of alcohol use disorder. METHODS: This retrospective study was conducted with 976 adults who visited the Sun Health Screening Center for health screenings in 2015. Daily drinking amount, drinking frequency per week, and weekly drinking amount were investigated. Using criteria from the National Institute on Alcohol Abuse and Alcoholism, participants were classified as normal drinkers, heavy drinkers, or binge drinkers, and grouped by age and sex. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of heavy and binge drinking were compared for the diagnosis of alcohol abuse and alcohol dependence using the Diagnostic and Statistical Manual of Mental Disorders (DSM) 4th edition-text revision and alcohol use disorder using the DSM 5th edition. RESULTS: The sensitivity of heavy and binge drinking for the diagnosis of alcohol abuse, alcohol dependence, and alcohol use disorder were 51.7%, 43.8%, and 35.3%, and 69.0%, 62.5%, and 48.2%, respectively. The specificity of these were 90.1%, 91.7%, and 95.5%, and 84.3%, 86.8%, and 91.2%, respectively. The PPV of these were 24.8%, 40.5%, and 72.7%, and 21.7%, 38.0%, and 65.2%, respectively. The NPV of these were 96.7%, 92.6%, and 81.2%, and 97.8%, 94.7%, and 83.7%, respectively. CONCLUSION: Heavy and binge drinking did not show enough diagnostic power to screen DSM alcohol use disorder although they did show high specificity and NPV.

Anti-tuberculosis Treatment-Induced Insulin Autoimmune Syndrome / 이화의대지

Insulin autoimmune syndrome, a rare cause of endogenous hyperinsulinemic hypoglycemia, is characterized by insulin autoantibody, hyperinsulinemia and fasting hypoglycemia. It is well known that drugs containing a sulfhydryl group such as methimazole or α-mercaptopropionyl glycine can induce insulin autoimmune syndrome. However, insulin autoimmune syndrome caused by anti-tuberculosis treatment is very rare. We report a case of insulin autoimmune syndrome after anti-tuberculosis treatment with a review of the relevant literature.

Assessment of Coronal Plane Malalignment Following Reduction of Trochanteric Fractures-Simple Intraoperative Guideline Using Greater Trochanter Orthogonal Line

PURPOSE: There is no consensus on a clear intraoperative guideline for judging the coronal plane alignment following reduction of trochanteric fractures. Complex angular measurements using fluoroscope monitors are tedious. Therefore the relation of the horizontal line from the tip of the greater trochanter (GT orthogonal) and femur head center (HC orthogonal) was studied to define this line as a criterion for predicting varus-valgus malalignment. MATERIALS AND METHODS: We studied this relation in 200 standing orthoradiograms which included 100 males and 100 females. The images were digitally analyzed using the picture archiving and communication system. GT orthogonal line and HC orthogonal line were evaluated. The distance of these lines was measured as trochanter center distance (TCD) and its correlation with angular parameters like neck shaft angle, medial proximal femoral angle with reference to anatomical axis (aMPFA) and lateral proximal femoral angle with reference to mechanical axis (mLPFA) were analyzed. RESULTS: In all patients, the GT orthogonal line passed either at or above the center of the head. Overall mean of TCD was 7.22 mm, ranging from 0 to 17.57 mm. TCD was found to show strong correlation with angular parameters like aMPFA, mLPFA and neck shaft angle. TCD was less than one fourth of the corresponding head diameter in around 90%. Therefore following reduction of trochanteric fractures, the GT orthogonal line should pass through the superior juxta central quadrant of the femoral head. CONCLUSION: This line can be represented by a guide wire with fluoroscopy during surgery. The GT orthogonal line can be used intraoperatively as a simplified tool for prediction of varus/valgus malalignment following the reduction of trochanteric fractures.

Myelomatous Pleural Effusion with Elevated ADA Activity / 대한내과학회지

Multiple myeloma is a plasma cell neoplasm mainly involving the bone marrow and skeletal system. Myelomatous pleural effusion is rare, accounting for less than 1%. In cases with high adenosine deaminase (ADA) activity, with lymphocytic exudate in the pleural fluid, tuberculous pleural effusion should be differentiated first. We report herein a rare case of a unilateral pleural effusion in a patient who was undergoing chemotherapy for multiple myeloma, with an ADA level of > 100 IU/L and lymphocytic exudate in the pleural fluid. An acid fast bacillus stain and polymerase chain reaction test for tuberculosis were negative. Consequently, the patient was diagnosed with myelomatous pleural effusion with elevated ADA activity.