Review of North Korean Reports on Cardiovascular Disease Research and Management

Purpose@#This study aimed to investigate the quality of medical care in North Korea using data from North Korean medical research. @*Materials and Methods@#This study included publications containing the keyword “medical” among North Korea’s consecutive publications and selected 415 papers related to heart disease, brain disease, and emergency medical care published at The North Korean Data Center of the Ministry of Unification (https://unibook.unikorea.go.kr). Among 40 research articles, we reviewed ten with representative epidemiological data for cardiovascular treatment, and the latest medical materials were selected and analyzed in detail. @*Results@#Few studies reported the experience of large-scale medical facilities or verified professional performance. Proof of the efficacy of the latest drugs was rare, although the treatment results of interventional therapy and conventional heart surgery were reported. Efforts to improve emergency medical care and innovation of treatment materials using new technologies were being actively studied. However, careful interpretation is required due to the lack of objectivity in research data and some deviation in the composition of patients included in the data. @*Conclusion@#Research of cardiovascular disease in North Korea is conducted at a very limited scope, although treatment results appear to be recorded. The management of cardiovascular disease and the establishment of an emergency medical system warrant global attention and cooperation for further improvement.

The First Case of Monkeypox in the Republic of Korea

A rapid outbreak of monkeypox is ongoing in non-endemic countries since May 2022. We report the first case of monkeypox in the Republic of Korea. This occurred in a 34-year-old male patient who traveled to Europe in June 2022. On the day of his return to the Republic of Korea (June 21, 2022), the patient presented with a genital lesion. The results of the monkeypox real-time polymerase chain reaction tests were positive in the penile ulcer, oropharyngeal and nasopharyngeal specimens. The patient subsequently developed fever and skin rash after hospital admission. Careful history taking along physical examination should be conducted in the patients who have epidemiologic risk factors for monkeypox. Moreover, appropriate specimens should be obtained from lesions and tested for the monkeypox virus.

A simple and novel equation to estimate the degree of bleeding in haemorrhagic shock: mathematical derivation and preliminary in vivo validation

Determining blood loss [100% – RBV (%)] is challenging in the management of haemorrhagic shock. We derived an equation estimating RBV (%) via serial haematocrits (Hct1 , Hct2 ) by fixing infused crystalloid fluid volume (N) as [0.015 × body weight (g)]. Then, we validated it in vivo. Mathematically, the following estimation equation was derived: RBV (%) = 24k / [(Hct1 / Hct2 ) – 1]. For validation, nonongoing haemorrhagic shock was induced in Sprague–Dawley rats by withdrawing 20.0%–60.0% of their total blood volume (TBV) in 5.0% intervals (n = 9). Hct1 was checked after 10 min and normal saline N cc was infused over 10 min. Hct 2 was checked five minutes later. We applied a linear equation to explain RBV (%) with 1 / [(Hct1 / Hct2 ) – 1]. Seven rats losing 30.0%–60.0% of their TBV suffered shock persistently. For them, RBV (%) was updated as 5.67 / [(Hct1 / Hct2 ) – 1] + 32.8 (95% confidence interval [CI] of the slope: 3.14–8.21, p = 0.002, R2 = 0.87). On a Bland-Altman plot, the difference between the estimated and actual RBV was 0.00 ± 4.03%; the 95% CIs of the limits of agreements were included within the pre-determined criterion of validation (< 20%). For rats suffering from persistent, non-ongoing haemorrhagic shock, we derived and validated a simple equation estimating RBV (%). This enables the calculation of blood loss via information on serial haematocrits under a fixed N.Clinical validation is required before utilisation for emergency care of haemorrhagic shock.

Distinct Repopulation Activity in Hu-Mice between CBand LPB-CD34＋ Cells by Enrichment of Transcription Factors

Background and Objectives@#Human CD34＋hematopoietic stem cells can reconstitute the human hematopoietic system when transplanted into immunocompromised mice after irradiation. Human leukapheresis peripheral blood (LPB)-and cord blood (CB)-derived CD34＋ cells have a similar capacity to reconstitute myeloid lineage cells in a humanized mice (hu-mice) model. However, potent stem cells, such as CB-CD34＋ cells, efficiently reconstitute the lymphoid system in vivo compared to LPB-CD34 ＋ cells. Modeling the human hematolymphoid system is vital for studying immune cell crosstalk in human xenografted mice, with CB-CD34＋ cells used as an optimized cell source because they are essential in reconstituting lymphoid lineage cells. @*Methods@#and Results: In this study, we established hu-mice that combined human characteristics with long-term survival and investigated the efficiency of the engraftment of lymphoid lineage cells derived from LPB- and CB-CD34＋cells in the bone marrow, spleen, and LPB. We found an overall increase in the transcriptional activity of lymphoid lineage genes in CB-CD34＋ cells. Our results revealed that potent CB-CD34＋ cells displaying a general upregulation of the expression of genes involved in lymphopoiesis could contribute to the hematolymphoid system in the humanized mice model with longevity. @*Conclusions@#Our data suggest that humanized mouse model by usage of CB-CD34 ＋ cells displaying high expression of TFs for lymphoid lineage cells can contribute to study the immune response against lymphocytes.

Distinct Repopulation Activity in Hu-Mice between CBand LPB-CD34＋ Cells by Enrichment of Transcription Factors

Background and Objectives@#Human CD34＋hematopoietic stem cells can reconstitute the human hematopoietic system when transplanted into immunocompromised mice after irradiation. Human leukapheresis peripheral blood (LPB)-and cord blood (CB)-derived CD34＋ cells have a similar capacity to reconstitute myeloid lineage cells in a humanized mice (hu-mice) model. However, potent stem cells, such as CB-CD34＋ cells, efficiently reconstitute the lymphoid system in vivo compared to LPB-CD34 ＋ cells. Modeling the human hematolymphoid system is vital for studying immune cell crosstalk in human xenografted mice, with CB-CD34＋ cells used as an optimized cell source because they are essential in reconstituting lymphoid lineage cells. @*Methods@#and Results: In this study, we established hu-mice that combined human characteristics with long-term survival and investigated the efficiency of the engraftment of lymphoid lineage cells derived from LPB- and CB-CD34＋cells in the bone marrow, spleen, and LPB. We found an overall increase in the transcriptional activity of lymphoid lineage genes in CB-CD34＋ cells. Our results revealed that potent CB-CD34＋ cells displaying a general upregulation of the expression of genes involved in lymphopoiesis could contribute to the hematolymphoid system in the humanized mice model with longevity. @*Conclusions@#Our data suggest that humanized mouse model by usage of CB-CD34 ＋ cells displaying high expression of TFs for lymphoid lineage cells can contribute to study the immune response against lymphocytes.

Effect of Preoperative Warming on Prevention of Hypothermia during Surgery in Patients with Total Hip Replacement Arthroplasty under Spinal Anesthesia / 임상간호연구

Purpose@#The purpose of this study was to evaluate the effect of preoperative warming to prevent hypothermia in surgery for patients undergoing total hip replacement arthroplasty under spinal anesthesia. @*Methods@#A randomized experimental study was conducted. Data were collected at an S University hospital in Gyeonggido from December 3, 2019 to March 31, 2020. A random allocation program was used to randomize participants into intervention and control groups. A total of 90 participants were assigned to the study: 30 people were randomized to a pre-warming group using Bair Hugger forced-air warming blankets(Model 505) 30 minutes before surgery, 30 to a pre-warming group 15 minutes before surgery, or 30 to a control group. The findings from 88 participants were analyzed. For data analysis, x2 test and ANOVA were used utilizing the SPSS 21.0 program. @*Results@#The pre-warming group 30 minutes before surgery had significantly higher body temperature than the control group, from 30 minutes after inducing anesthesia to the end of anesthesia. Body temperature over anesthesia time showed significant differences among the three groups, but there were no statistically significant differences in interactions between time and groups. @*Conclusion@#Warming patients' body for 30 minutes before surgery was effective in maintaining normal body temperature while preventing intraoperative hypothermia.

Effect of Preoperative Warming on Prevention of Hypothermia during Surgery in Patients with Total Hip Replacement Arthroplasty under Spinal Anesthesia / 임상간호연구

Purpose@#The purpose of this study was to evaluate the effect of preoperative warming to prevent hypothermia in surgery for patients undergoing total hip replacement arthroplasty under spinal anesthesia. @*Methods@#A randomized experimental study was conducted. Data were collected at an S University hospital in Gyeonggido from December 3, 2019 to March 31, 2020. A random allocation program was used to randomize participants into intervention and control groups. A total of 90 participants were assigned to the study: 30 people were randomized to a pre-warming group using Bair Hugger forced-air warming blankets(Model 505) 30 minutes before surgery, 30 to a pre-warming group 15 minutes before surgery, or 30 to a control group. The findings from 88 participants were analyzed. For data analysis, x2 test and ANOVA were used utilizing the SPSS 21.0 program. @*Results@#The pre-warming group 30 minutes before surgery had significantly higher body temperature than the control group, from 30 minutes after inducing anesthesia to the end of anesthesia. Body temperature over anesthesia time showed significant differences among the three groups, but there were no statistically significant differences in interactions between time and groups. @*Conclusion@#Warming patients' body for 30 minutes before surgery was effective in maintaining normal body temperature while preventing intraoperative hypothermia.

Pneumoperitoneum after Endoscopic Duodenal Stent Insertion in a Patient with Percutaneous Transhepatic Biliary Drainage and Biliary Stent: A Case Report

Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PTBD tube. An 84-year-old man was admitted with type III combined duodenal and biliary obstruction secondary to metastatic bladder cancer. A biliary stent was placed using a percutaneous approach, and a duodenal stent was placed endoscopically. A large amount of subphrenic free air was detected after the procedures. Laboratory tests indicated intestinal perforation; however, peritoneal signs were absent. The patient was treated conservatively using an indwelling Levin tube. Seven days later, the massive amount of subphrenic free air disappeared. Follow-up tubography revealed unrestricted bile flow into the small intestine, and the PTBD tube was removed. Prolonged endoscopic procedures in patients with a PTBD tract communicating with the gastrointestinal tract can precipitate pneumoperitoneum. Clinicians should be careful to avoid misdiagnosing this condition as intestinal perforation.

Factors associated with Experience of Diagnosis and Utilization of Chronic Diseases among Korean Elderly : Focus on Comparing between Urban and Rural Elderly / 農村醫學 地域保健

OBJECTIVES@#The purpose of this study was to identify and compare the difference and related factors with general characteristic and health behaviors, a experience of diagnosis and treatment of chronic diseases between rural and urban among elderly in Korea.@*METHODS@#We used the data of Community Health Survey 2017 which were collected by the Korean Center for Disease Control and Prevention. The study population comprised 67,835 elderly peopled aged 65 years or older who participated in the survey. The chi-square test, univariate and multivariate logistic regression analysis were used to analyze data.@*RESULTS@#We identified many significant difference of health behaviors, an experience of diagnosis and treatment with chronic diseases between rural and urban. Compared to urban elderly, the odds ratios (ORs) (95% confidence interval) of rural elderly were 1.136 (1.092–1.183) for diagnosis of diabetes, 1.278 (1.278–1.386) for diagnosis of dyslipidemia, 0.940 (0.904–0.977) for diagnosis of arthritis, 0.785(0.736–0.837) for treatment of arthritis, 1.159 (1.116–1.203) for diagnosis of cataracts, and 1.285(1.200–1.375) for treatment of cataracts. In the experience of diagnosis and treatment of chronic diseases, various variables were derived as contributing factors for each disease. Especially, there were statistically significant difference in the experience of diabetes diagnosis, arthritis diagnosis, cataract diagnosis and dyslipidemia except for hypertension diagnosis (p<0.01) between urban and rural elderly. There were statistically significant differences in the experience of treatment for arthritis and cataract (p<0.01), but there was no significant difference in the experience of treatment for hypertension, diabetes, dyslipidemia between urban and rural elderly.@*CONCLUSION@#Therefore, it would be necessary to implement a strategic health management project for diseases that showed significant experience of chronic diseases with diagnosis and treatment, reflecting the related factors of the elderly chronic diseases among the urban and rural areas.

Nurses' Evidence-Based Practice Beliefs and Competencies, and Organizational Supports / 임상간호연구

PURPOSE: The aim of this study was to assess nurses' evidence-based practice (EBP) beliefs and competencies, and organizational supports to develop EBP. METHODS: A descriptive study was conducted using a survey of clinical nurses at a tertiary hospital in South Korea. RESULTS: The survey was distributed to a total of 1,413 nurses and was completed by 1,318 nurses. There were significant differences in the EBP beliefs and competencies, and the perception of organizational supports among nurses at different educational levels. The EBP beliefs, EBP competencies, and organizational supports had a positive correlation with each other. EBP competencies were the highest in nurses with less than 3-years of clinical experience, and the perception of organization supports were the highest in nurses with more than 10-years of clinical experience. CONCLUSION: The findings suggest that educational programs, training, and organizational supports are recommended for facilitating successful EBP among nurses.

Effects of Delirium Prevention Interventions for Neurocritical Patients / 기본간호학회지

PURPOSE: The purpose of this study was to investigate the effects of a delirium prevention intervention for patients in neurology and neurosurgery intensive care units (ICUs). METHODS: This study was a quasi-experimental study. Participants were 87 patients. The experimental group was provided with nonpharmacologic and multicomponent delirium prevention interventions, consisting of regular delirium assessment, improvement in orientation, early therapeutic intervention, and environmental interventions. The control group was provided with routine intensive care. Data were analyzed using χ² test, Fisher's exact test, and t-test. RESULTS: Both groups were homogeneous. The incidence of delirium and length of hospitalization were significantly lower in the experimental group compared to the control group. ICU stay, mortality and unplanned extubation were lower in the experimental group compared to the control group, but there was no significant difference. CONCLUSION: Findings indicate that the delirium prevention intervention is effective in reducing incidence of delirium and length of hospitalization. Therefore, this intervention should be helpful in preventing delirium in neurology and neurosurgery ICUs and can be used as a guide in the prevention of delirium in neurological diseases's patients.

Association Analysis between Chromogranin B Genetic Variations and Smooth Pursuit Eye Movement Abnormality in Korean Patients with Schizophrenia

OBJECTIVES: According to previous studies, the Chromogranin B (CHGB) gene could be an important candidate gene for schizophrenia which is located on chromosome 20p12.3. Some studies have linked the polymorphism in CHGB gene with the risk of schizophrenia. Meanwhile, smooth pursuit eye movement (SPEM) abnormality has been regarded as one of the most consistent endophenotype of schizophrenia. In this study, we investigated the association between the polymorphisms in CHGB gene and SPEM abnormality in Korean patients with schizophrenia. METHODS: We measured SPEM function in 24 Korean patients with schizophrenia (16 male, 8 female) and they were divided according to SPEM function into two groups, good and poor SPEM function groups. We also investigated genotypes of polymorphisms in CHGB gene in each group. A logistic regression analysis was performed to find the association between SPEM abnormality and the number of polymorphism. RESULTS: The natural logarithm value of signal/noise ratio (Ln S/N ratio) of good SPEM function group was 4.19 ± 0.19 and that of poor SPEM function group was 3.17 ± 0.65. In total, 15 single nucleotide polymorphisms of CHGB were identified and the genotypes were divided into C/C, C/R, and R/R. Statistical analysis revealed that two genetic variants (rs16991480, rs76791154) were associated with SPEM abnormality in schizophrenia (p = 0.004). CONCLUSIONS: Despite the limitations including a small number of samples and lack of functional study, our results suggest that genetic variants of CHGB may be associated with SPEM abnormality and provide useful preliminary information for further study.

Evaluation of the Cortical Vitreous Using Swept-Source Optical Coherence Tomography in Normal Eyes

PURPOSE: To observe the shape of posterior vitreous spaces using swept-source optical coherence tomography (SS-OCT) in normal eyes. METHODS: The posterior vitreous of 80 eyes of 80 volunteers without ocular disease was imaged. The DRI OCT-1 Atlantis (Topcon, Oakland, NJ, USA) was used to acquire scans of the posterior vitreous over an 18 × 18-mm2 area using the 12-mm horizontal line scan protocol. The size of the premacularis bursa was measured by the aliper function of the OCT. RESULTS: A boat-shape bursa was found in most cases. The prevalence of detected bursa fell with further increases in the extent of posterior vitreous detachment. The mean width of the bursa premacularis was 7,679.1 µm and the mean depth was 471.4 µm. CONCLUSIONS: Deep range imaging optical coherence tomography will provide improvement for in vivo anatomic characterization of the cortical vitreous, and allow better visualization of the dimensions of the bursa premacularis.

Evaluation of the Cortical Vitreous Using Swept-Source Optical Coherence Tomography in Normal Eyes

PURPOSE: To observe the shape of posterior vitreous spaces using swept-source optical coherence tomography (SS-OCT) in normal eyes. METHODS: The posterior vitreous of 80 eyes of 80 volunteers without ocular disease was imaged. The DRI OCT-1 Atlantis (Topcon, Oakland, NJ, USA) was used to acquire scans of the posterior vitreous over an 18 × 18-mm2 area using the 12-mm horizontal line scan protocol. The size of the premacularis bursa was measured by the aliper function of the OCT. RESULTS: A boat-shape bursa was found in most cases. The prevalence of detected bursa fell with further increases in the extent of posterior vitreous detachment. The mean width of the bursa premacularis was 7,679.1 µm and the mean depth was 471.4 µm. CONCLUSIONS: Deep range imaging optical coherence tomography will provide improvement for in vivo anatomic characterization of the cortical vitreous, and allow better visualization of the dimensions of the bursa premacularis.

Different Strategies for Transpancreatic Septotomy and Needle Knife Infundibulotomy Due to the Presence of Unintended Pancreatic Cannulation in Difficult Biliary Cannulation

BACKGROUND/AIMS: Several precut techniques have been used to gain biliary access for difficult cases. The aim of this study was to evaluate the success and complication rates of two precut techniques, transpancreatic septotomy (TPS) and needle knife infundibulotomy (NKI), in difficult biliary cannulation due to the presence of unintended pancreatic cannulation. METHODS: Eighty-six patients who failed standard biliary cannulation were included. TPS was performed when we failed to achieve biliary access despite 5 minutes of attempted cannulation or when more than three attempted unintended pancreatic cannulations occurred. If deep cannulation was not achieved within 5 minutes for any duct, NKI was performed. If this failed, we crossed over to the other technique in the second attempt. RESULTS: The initial total success rate of biliary cannulation was 88.4% (86.6% for the TPS group and 94.7% for the NKI group, p=0.447). After crossover of the techniques, the final success rate was 95.3%. The complication rate was 20.9% in patients with TPS and 15.8% in patients with NKI (p=0.753). CONCLUSIONS: The use of different strategies based on the presence of unintended pancreatic cannulation may help increase the success rate for difficult biliary cannulation without increasing complication rates.

Relationship between Family Meals and Depressive Symptoms in Children / 가정의학회지

BACKGROUND: Recently, importance of family meals has been emphasized at home and abroad, and several journals reported that family meals had a big impact on children's development. In this paper, we would like to report the relationship between family meals and depressive symptoms in children. METHODS: This study was based on questionnaires distributed to 162 5th and 6th graders of one elementary school in the area of Daegu, Korea, in July, 2010. The questionnaire was about general characteristics, family characteristics, and quantity/quality of family meals. Family functions and depressive symptoms in children were evaluated with Smilkstein's family APGAR (adaptability, partnership, growth, affection, and resolve) score (FAS) and Kovac's Children's Depression Inventory (CDI). RESULTS: In one-way analyses of variance, there was no significant difference in FAS and CDI according to general and family characteristics (P > 0.05). CDI was significantly lower in the group having more frequent family meals (P 0.05). CONCLUSION: The frequency of family meals, having more conversation and better atmosphere during family meals predicted less depressive symptoms in children.

Endoscopic ultrasound-guided fine needle aspiration of solid pseudopapillary tumors of the pancreas: a report of three cases

The solid pseudopapillary tumor (SPT) of the pancreas is a rare but low-grade malignant tumor with a good prognosis after surgical excision. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is a minimally invasive, safe and reliable way of diagnosing SPT by providing characteristic cytological and immunochemical specimens. Definitive preoperative diagnosis leads to targeted and minimally invasive surgical resection. In this study, we report three cases of SPTs that were diagnosed through EUS-FNA and underwent successful laparoscopic surgery.

Thoracolumbar Junction Syndrome Causing Pain around Posterior Iliac Crest: A Case Report / 가정의학회지

Thoracolumbar junction syndrome is characterized by referred pain which may originate at the thoracolumbar junction, which extends from 12th thoracic vertebra to 2nd lumbar vertebra, due to functional abnormalities. Clinical manifestations include back pain, pseudo-visceral pain and pseudo-pain on the posterior iliac crest, as well as irritable bowel symptoms. During clinical examination, pain can be demonstrated by applying pressure on the facet joints or to the sides of the spinous processes. Radiological studies show only mild and insignificant degenerative changes in most cases. We report a 42-year-old female patient with osteogenesis imperfecta who suffered from chronic low back pain. Under the diagnosis of thoracolumbar junction syndrome, she was treated with an epidural block and a sympathetic nerve block, which improved her symptoms.

Actinomycosis in Pancreas and Psoas Muscle / 대한소화기학회지

No abstract available.

A Case of Spontaneous Remission of Acute Pulmonary Embolism / 결핵및호흡기질환

Acute pulmonary embolism (PE) ranges from asymptomatic to often fatal, incidentally discovered emboli to massive embolism causing immediate death. Acute PE may occur rapidly and unpredictably and may be difficult to diagnose. Mortality and complications can be reduced by prompt diagnosis and therapy. Untreated PE is associated with a mortality rate of approximately 30 percents. Most patients with PE have endogenous fibrinolysis, although it is not effective enough to prevent PE. A case of spontaneous remission of untreated acute PE has not previously been reported. Here we present a case of spontaneously resolved acute PE without any treatment.