Bone Age Estimation and Prediction of Final Adult Height Using Deep Learning

Purpose@#The appropriate evaluation of height and accurate estimation of bone age are crucial for proper assessment of the growth status of a child. We developed a bone age estimation program using a deep learning algorithm and established a model to predict the final adult height of Korean children. @*Materials and Methods@#A total of 1678 radiographs from 866 children, for which the interpretation results were consistent between two pediatric endocrinologists, were used to train and validate the deep learning model. The bone age estimation algorithm was based on the convolutional neural network of the deep learning system. The test set simulation was performed by a deep learning program and two raters using 150 radiographs and final height data for 100 adults. @*Results@#There was a statistically significant correlation between bone age interpreted by the artificial intelligence (AI) program and the reference bone age in the test set simulation (r=0.99, p<0.001). In the test set simulation, the AI program showed a mean absolute error (MAE) of 0.59 years and a root mean squared error (RMSE) of 0.55 years, compared with reference bone age, and showed similar accuracy to that of an experienced pediatric endocrinologist (rater 1). Prediction of final adult height by the AI program showed an MAE of 4.62 cm, compared with the actual final adult height. @*Conclusion@#We developed a bone age estimation program based on a deep learning algorithm. The AI-derived program demonstrated high accuracy in estimating bone age and predicting the final adult height of Korean children and adolescents.

Testosterone to Luteinizing Hormone Ratio as a Potential Predictor of Sperm Retrieval in Non-Obstructive Azoospermia Patients

Purpose@#This study assessed the outcomes of microsurgical testicular sperm extraction (mTESE) and potential preoperative predictors of sperm retrieval (SR) in patients with non-obstructive azoospermia (NOA). @*Materials and Methods@#Clinical data of 111 NOA patients who underwent mTESE was reviewed retrospectively. Baseline patient characteristics, including age, body mass index (BMI), testicular volumes, and preoperative endocrine levels, such as testosterone (T), follicle-stimulating hormone (FSH), serum-luteinizing hormone (LH), prolactin, sex hormone-binding globulin (SHBG), FSH/LH ratio along with T/LH ratio, were analyzed. After categorizing the patients into two groups based on SR success or failure, logistic regression analysis was performed to identify the preoperative predictors of successful SR. @*Results@#Sixty-eight patients had successful SR (61.3%), whereas 43 patients (38.7%) showed negative results. Failed SR group had elevated serum FSH and LH levels, whereas successful SR patients had a significantly larger testicular volume (p<0.001). Moreover, the successful group had a higher T/LH ratio (p<0.001). Multivariate logistic analysis showed that the T/LH ratio, serum FSH levels, and bilateral testicular volumes were significantly associated with successful sperm extraction. @*Conclusion@#In addition to traditional predictors, such as testicular volume and preoperative FSH levels, the T/LH ratio is a potential independent predictor of successful SR in infertile patients with NOA.

The Effect of the Mechanical Properties of the 3D Printed Gelatin/ Hyaluronic Acid Scaffolds on hMSCs Differentiation Towards Chondrogenesis

BACKGROUND@#Tissue engineering, including 3D bioprinting, holds great promise as a therapeutic tool for repairing cartilage defects. Mesenchymal stem cells have the potential to treat various fields due to their ability to differentiate into different cell types. The biomimetic substrate, such as scaffolds and hydrogels, is a crucial factor that affects cell behavior, and the mechanical properties of the substrate have been shown to impact differentiation during incubation. In this study, we examine the effect of the mechanical properties of the 3D printed scaffolds, made using different concentrations of cross-linker, on hMSCs differentiation towards chondrogenesis. @*METHODS@#The 3D scaffold was fabricated using 3D bioprinting technology with gelatin/hyaluronic acid (HyA) biomaterial ink. Crosslinking was achieved by using different concentrations of 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methlymorpholinium chloride n-hydrate (DMTMM), allowing for control of the scaffold’s mechanical properties. The printability and stability were also evaluated based on the concentration of DMTMM used. The effects of the gelatin/HyA scaffold on chondrogenic differentiation was analyzed by utilizing various concentrations of DMTMM. @*RESULTS@#The addition of HyA was found to improve the printability and stability of 3D printed gelatin/HyA scaffolds.The mechanical properties of the 3D gelatin/HyA scaffold could be regulated through the use of different concentrations of DMTMM cross-linker. In particular, the use of 0.25 mM DMTMM for crosslinking the 3D gelatin/HyA scaffold resulted in enhanced chondrocyte differentiation. @*CONCLUSION@#The mechanical properties of 3D printed gelatin/HyA scaffolds cross-linked using various concentrations of DMTMM can influence the differentiation of hMSCs into chondrocytes.

Differences in facial soft tissue deviations in Class III patients with different types of mandibular asymmetry: A cone-beam computed tomography study / 대한치과교정학회지

Objective@#This study assessed the differences in soft tissue deviations of the nose, lips, and chin between different mandibular asymmetry types in Class III patients. @*Methods@#Cone-beam computed tomography data from 90 Class III patients with moderate-to-severe facial asymmetry were investigated. The sample was divided into three groups based on the extent of mandibular rolling, yawing, and translation. Soft tissue landmarks on the nose, lips, and chin were investigated vertically, transversely, and anteroposteriorly. A paired t test was performed to compare variables between the deviated (Dv) and nondeviated (NDv) sides, and one-way analysis of variance with Tukey’s post-hoc test was performed for intergroup comparisons. Pearson’s correlation coefficient was calculated to assess the relationship between the soft and hard tissue deviations. @*Results@#The roll-dominant group showed significantly greater differences in the vertical positions of the soft tissue landmarks between the Dv and NDv than other groups (P < 0.05), whereas the yaw-dominant group exhibited larger differences in the transverse and anteroposterior directions (P < 0.05). Moreover, transverse lip cant was correlated with the menton (Me) deviation and mandibular rolling in the roll-dominant group (P < 0.001); the angulation of the nasal bridge or philtrum was correlated with the Me deviation and mandibular yawing in the yaw-dominant group (P < 0.01). @*Conclusions@#The threedimensional deviations of facial soft tissue differed based on the mandibular asymmetry types in Class III patients with similar amounts of Me deviation. A precise understanding of soft tissue deviation in each asymmetry type would help achieve satisfactory facial esthetics.

Differences in positions of cone-beam computed tomography landmarks in patients with skeletal Class III facial asymmetry according to midsagittal planes / 대한치과교정학회지

Objective@#This study aimed to clarify differences in the positions of cone-beam computed tomography (CBCT) landmarks according to different midsagittal planes (MSPs) in patients with skeletal Class III facial asymmetry. @*Methods@#Pre-treatment CBCT data from 60 patients with skeletal Class III were used.The patients were classified into symmetric (menton deviations of 4 mm) groups. Six MSPs were established based on previous studies, and three-dimensional analyses were performed for the planes in both the groups. The measurement outcomes were compared statistically. @*Results@#A statistically significant interaction (p < 0.01) was observed between MSPs and facial asymmetry. No significant differences were observed among MSPs in the symmetric group. However, significant differences in linear measurements were identified among MSPs in the asymmetric group. Specifically, the upper facial MSP revealed both maxillary and mandibular transverse asymmetries. On the other hand, anterior nasal spine (ANS)-associated MSP could not identify maxillary asymmetry. Furthermore, the menton deviation was approximately 3 mm lower when estimated using the ANS-associated MSP than that using upper facial MSP. @*Conclusions@#The choice of MSP can significantly affect treatment outcomes while diagnosing patients with asymmetry. Therefore, care should be taken when selecting MSP in clinical practice.

Prognostic role of the neutrophil-to-lymphocyte ratio in patients with chronic kidney disease

Background/Aims@#The neutrophil-to-lymphocyte ratio (NLR) has a prognostic value in cardiovascular disease, infection, inflammatory disease, and several malignancies. Therefore, the NLR has a possible predictive value in patients with chronic kidney disease (CKD), but this predictive value has not been validated. Here, we aimed to investigate the possibility of NLR as a predictor of CKD progression. @*Methods@#This retrospective observational study included 141 patients with non-dialysis CKD. The participants were divided into terciles (T1, T2, and T3) according to NLR. The primary outcome was defined as a composite kidney event, which included a decline in the estimated glomerular filtration rate (eGFR) of at least 50% or initiation of renal replacement therapy during the follow-up period. @*Results@#The mean follow-up duration was 5.45 ± 2.11 years. The mean NLRs were 1.35 ± 0.05 in T1 (n = 47), 2.16 ± 0.04 in T2 (n = 47), and 4.29 ± 0.73 in T3 (n = 47). The group with the highest NLR (T3) had higher baseline CKD and serum creatinine and lower eGFR levels than the group with the lowest NLR (T1). The cumulative incidence rate of composite kidney events was significantly higher in T3 compared with T1 (p < 0.001, log-rank test). Cox regression analysis revealed that high NLR was associated with the risk of composite kidney events (adjusted hazard ratio, 3.33; 95% confidence interval, 1.43–7.76). @*Conclusions@#A higher NLR reflects the more advanced stage of CKD and suggests a role for NLR as a biomarker for predicting CKD progression.

The Effect of Psychological Factors on COVID-19 Vaccination Side Effects: A Cross-Sectional Survey in South Korea

Objective@#Side effects from the coronavirus disease-2019 (COVID-19) vaccine, such as pain, headache, nausea, and fatigue, have caused vaccine hesitancy. Research on the effects of psychological factors on COVID-19 vaccine side effects is insufficient. This study aims to investigate the effect of psychological factors on COVID-19 vaccination side effects. @*Methods@#We recruited a total of 226 individuals registered for the COVID-19 vaccine in Seoul, South Korea, for this study. Participants completed a pre-vaccination questionnaire, including the 5C antecedents of vaccination, and a survey of psychological factors (Patient Health Questionnaire–9 [PHQ-9], Generalized Anxiety Disorder–7, Somatic symptom amplification scale [SSAS], and Illness Attitude Scale [IAS]). After vaccination, participants completed an online questionnaire regarding vaccine side effects at 20 minutes, three days, and seven days after vaccination. We added a discrete set of hierarchical variables with vaccine side effects as the dependent variable to the hierarchical regression analysis: demographics for Model 1, 5C antecedents of vaccination for Model 2, and psychological factors for Model 3. @*Results@#Our results indicated that the risk factors for side effects 20 minutes after vaccination were young age, high PHQ, and SSAS scores. Risk factors for side effects three days after vaccination were young age, high constraints, and calculation, and the risk factor for side effects at seven days was a high IAS score. @*Conclusion@#Our study confirmed that there is a significant relationship between psychological factors and COVID-19 vaccine side effects in chronological order. Psychosocial factors should be examined when assessing side-effect reactions to the COVID-19 vaccine.

Significance of Triglyceride-to-HighDensity Lipoprotein Cholesterol Ratio in Children with Non-Alcoholic Fatty Liver Disease / 대한소아소화기영양학회지

Purpose@#Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and metabolic syndrome. This study evaluated the significance of markers such as the triglyceride-to-highdensity lipoprotein cholesterol (TG/HDL-C) ratio and TG-glucose (TyG) indices in a group of patients with NAFLD. @*Methods@#We retrospectively analyzed the data of patients aged 5–18 years diagnosed with NAFLD between January 2014 and January 2021. @*Results@#Among the 151 patients with NAFLD, 79.5% were found to be obese, and the mean TG/HDL-C ratio (3.78±2.54 vs. 3.13±2.24) and TyG index (4.69±0.28 vs. 4.56±0.30) were slightly higher in patients with obesity compared to those without obesity. Patients with severe hepatic steatosis had a significantly higher mean TG/HDL-C ratio (4.11±2.16 vs. 3.11±2.30, p=0.035) than those with mild to moderate steatosis. Severe hepatic steatosis grade was defined as an area under the receiver operating characteristic curve of the TG/HDL-C ratio of 0.760 (95% confidence interval, 0.544–0.875), with an optimal cutoff value of 3.37. @*Conclusion@#A high TG/HDL-C ratio is associated with severe hepatic steatosis and diabetes mellitus in children with NAFLD. Measurement of this ratio can help clinicians in identifying patients and targeting them for treatment and follow-up.

Results of contact tracing for SARS-CoV-2 Omicron sub-lineages (BA.4, BA.5, BA.2.75) and the household secondary attack risk

Objectives@#This study aimed to assess the contact tracing outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron sub-lineages BA.4, BA.5, and BA.2.75 within Republic of Korea, and to generate foundational data for responding to future novel variants. @*Methods@#We conducted investigations and contact tracing for 79 confirmed BA.4 cases, 396 confirmed BA.5 cases, and 152 confirmed BA.2.75 cases. These cases were identified through random sampling of both domestically confirmed and imported cases, with the goal of evaluating the pattern of occurrence and transmissibility. @*Results@#We detected 79 instances of Omicron sub-lineage BA.4 across a span of 46 days, 396 instances of Omicron sub-lineage BA.5 in 46 days, and 152 instances of Omicron sub-lineage BA.2.75 over 62 days. One patient with severe illness was confirmed among the BA.5 cases; however, there were no reports of severe illness in the confirmed BA.4 and BA.2.75 cases. The secondary attack risk among household contacts were 19.6% for BA.4, 27.8% for BA.5, and 24.3% for BA.2.75. No statistically significant difference was found between the Omicron sub-lineages. @*Conclusion@#BA.2.75 did not demonstrate a higher tendency for transmissibility, disease severity, or secondary attack risk within households when compared to BA.4 and BA.5. We will continue to monitor major SARS-CoV-2 variants, and we plan to enhance the disease control and response systems.

Increased viral load in patients infected with severe acute respiratory syndrome coronavirus 2 Omicron variant in the Republic of Korea

Objectives@#Coronavirus disease 2019 (COVID-19) has been declared a global pandemic owingto the rapid spread of the causative agent, severe acute respiratory syndrome coronavirus 2.Its Delta and Omicron variants are more transmissible and pathogenic than other variants.Some debates have emerged on the mechanism of variants of concern. In the COVID-19 wave that began in December 2021, the Omicron variant, first reported in South Africa, became identifiable in most cases globally. The aim of this study was to provide data to inform effective responses to the transmission of the Omicron variant. @*Methods@#The Delta variant and the spike protein D614G mutant were compared with the Omicron variant. Viral loads from 5 days after symptom onset were compared usingepidemiological data collected at the time of diagnosis. @*Results@#The Omicron variant exhibited a higher viral load than other variants, resulting in greater transmissibility within 5 days of symptom onset. @*Conclusion@#Future research should focus on vaccine efficacy against the Omicron variant and compare trends in disease severity associated with its high viral load.

Sleep-potentiating Effects of Passiflora incarnata and ‘Heukharang’, a Novel Korean Lactuca sativa, on Pentobarbital-induced Sleep in Mice

Sleep deprivation or insomnia is one of the most common but neglected health conditions, with serious long-term consequences. In addition, insomnia is linked to poor work performance, impaired memory, and lack of concentration. Improving sleep quality is a crucial aspect of health care. Hypnotic agents, such as benzodiazepines, antidepressants, and antihistamines, are often used to enhance sleep quality; however, these medications often result in tolerance and dependence, resulting in withdrawal syndrome upon discontinuation. In recent years, studies have focused on natural and herbal therapies as alternative sleep aids to overcome the adverse effects of available sleep medications. Plant extracts contain phytochemicals that exert anxiolytic and sedative properties. This includes Passiflora incarnata (FSD-PI) and Lactuca sativa L. (FSD-LS) which can induce sleep. Herein, we assessed the effects of natural products, FSD-PI and FSD-LS, as well as their synergistic effects on pentobarbital sleep-induced ICR mice. We observed that natural extracts did not cause any behavioral changes capable of negative effects in mice. Furthermore, sleep duration was prolonged in pentobarbital-treated mice administered with FSD-LS (100 mg/kg). Our data suggest that FSD-LS may be a safe and effective sleep promoter.

Disseminated Staphylococcus aureus infection and acute bacterial pericarditis: a case report / 고신대학교의과대학학술지

We experienced a case of disseminated Staphylococcus aureus infection with bacterial pericarditis that progressed to septic shock and multiorgan failure despite pericardiocentesis and surgical removal of the original abscess with intensive antibiotic therapy. We report this case because of the patient’s very rare and remarkable echocardiographic findings and highly turbid pericardial effusion.

Chemotherapy-Related Cardiac Dysfunction:Quantitative Cardiac Magnetic Resonance Image Parameters and Their Prognostic Implications

Objective@#To quantitatively analyze the cardiac magnetic resonance imaging (CMR) characteristics of chemotherapy-related cardiac dysfunction (CTRCD) and explore their prognostic value for major adverse cardiovascular events (MACE). @*Materials and Methods@#A total of 145 patients (male:female = 76:69, mean age = 63.0 years) with cancer and heart failure who underwent CMR between January 2015 and January 2021 were included. CMR was performed using a 3T scanner (Siemens). Biventricular functions, native T1 T2, extracellular volume fraction (ECV) values, and late gadolinium enhancement (LGE) of the left ventricle (LV) were compared between those with and without CTRCD. These were compared between patients with mild-to-moderate CTRCD and those with severe CTRCD. Cox proportional hazard regression analysis was used to evaluate the association between the CMR parameters and MACE occurrence during follow-up in the CTRCD patients. @*Results@#Among 145 patients, 61 had CTRCD and 84 did not have CTRCD. Native T1, ECV, and T2 were significantly higher in the CTRCD group (1336.9 ms, 32.5%, and 44.7 ms, respectively) than those in the non-CTRCD group (1303.4 ms, 30.5%, and 42.0 ms, respectively; P = 0.013, 0.010, and < 0.001, respectively). They were not significantly different between patients with mild-to-moderate and severe CTRCD. Indexed LV mass was significantly smaller in the CTRCD group (65.0 g/m2 vs. 78.9 g/m2 ; P < 0.001). According to the multivariable Cox regression analysis, T2 (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.01–1.27; P = 0.028) and quantified LGE (HR: 1.07, 95% CI: 1.01–1.13; P = 0.021) were independently associated with MACE in the CTRCD patients. @*Conclusion@#Quantitative parameters from CMR have the potential to evaluate myocardial changes in CTRCD. Increased T2 with reduced LV mass was demonstrated in CTRCD patients even before the development of severe cardiac dysfunction. T2 and quantified LGE may be independent prognostic factors for MACE in patients with CTRCD.

Imaging of Facial Nerve With 3D-DESS-WE-MRI Before Parotidectomy: Impact on Surgical Outcomes

Objective@#The intra-parotid facial nerve (FN) can be visualized using three-dimensional double-echo steady-state waterexcitation sequence magnetic resonance imaging (3D-DESS-WE-MRI). However, the clinical impact of FN imaging using 3D-DESS-WE-MRI before parotidectomy has not yet been explored. We compared the clinical outcomes of parotidectomy in patients with and without preoperative 3D-DESS-WE-MRI. @*Materials and Methods@#This prospective, non-randomized, single-institution study included 296 adult patients who underwent parotidectomy for parotid tumors, excluding superficial and mobile tumors. Preoperative evaluation with 3D-DESS-WE-MRI was performed in 122 patients, and not performed in 174 patients. FN visibility and tumor location relative to FN on 3D-DESSWE-MRI were evaluated in 120 patients. Rates of FN palsy (FNP) and operation times were compared between patients with and without 3D-DESS-WE-MRI; propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to adjust for surgical and tumor factors. @*Results@#The main trunk, temporofacial branch, and cervicofacial branch of the intra-parotid FN were identified using 3D-DESSWE-MRI in approximately 97.5% (117/120), 44.2% (53/120), and 25.0% (30/120) of cases, respectively. The tumor location relative to FN, as assessed on magnetic resonance imaging, concurred with surgical findings in 90.8% (109/120) of cases. Rates of temporary and permanent FNP did not vary between patients with and without 3D-DESS-WE-MRI according to PSM (odds ratio, 2.29 [95% confidence interval {CI} 0.64–8.25] and 2.02 [95% CI: 0.32–12.90], respectively) and IPTW (odds ratio, 1.76 [95% CI: 0.19–16.75] and 1.94 [95% CI: 0.20–18.49], respectively). Conversely, operation time for surgical identification of FN was significantly shorter with 3D-DESS-WE-MRI (median, 25 vs. 35 min for PSM and 25 vs. 30 min for IPTW, P < 0.001). @*Conclusion@#Preoperative FN imaging with 3D-DESS-WE-MRI facilitated anatomical identification of FN and its relationship to the tumor during parotidectomy. This modality reduced operation time for FN identification, but did not significantly affect postoperative FNP rates.

Repeatability and Agreement of Chord Mu between Scheimpflug Tomography and Swept-Source Optical Coherence Tomography

Purpose@#To evaluate repeatability and agreement of chord mu between Scheimpflug tomography (Pentacam HR) and sweptsource optical coherence tomography–based optical biometer (IOLMaster 700). @*Methods@#In this retrospective study, 63 eyes from 33 patients were included. Chord mu, X and Y Cartesian distances between the corneal vertex and the pupil center (Px and Py), and the pupil diameter were compared using two instruments. Repeatability was evaluated using intraclass correlation coefficient (ICC), coefficient of variation (CoV), and within-subject standard deviation (Sw). Interdevice agreement was evaluated using paired t-tests and Bland-Altman plots. @*Results@#Although Sw values for all parameters were similar between the two devices, CoV values of chord mu and pupil diameter were lower, and ICC values of those parameters were higher, in the IOLMaster 700 than in the Pentacam HR. Chord mu and pupil diameter values were higher in IOLMaster 700 than Pentacam HR (p < 0.01). The width of the 95% limit of agreement was wide for all parameters. @*Conclusions@#IOLMaster 700 showed better repeatability than Pentacam HR in chord mu, Px, Py, and pupil diameter values. Because there were statistically significant differences and a low level of agreement in chord mu and pupil diameter values between the two devices, they cannot be used interchangeably.

Gender Difference of the Association between Energy Intake Expenditure Balance and Depression among Korean Adults: A Cross-Sectional Study from the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey / 가정의학회지

Background@#Diet and physical activity are key factors related to depressive mood. Previous studies have demonstrated the effects of diet and physical activity on depression. However, the effect of energy intake-expenditure balance (EIEB) on mental health has not been fully evaluated. This study aimed to analyze the association between EIEB and depression. @*Methods@#A total of 13,460 participants (5,660 men and 7,800 women) aged ≥19 years were obtained from the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey (KNHANES). EIEB was defined as the difference between the daily energy intake and energy expenditure. Energy intake was calculated and provided by the KNHANES using a 24-hour recall survey. Energy expenditure was estimated as the sum of basal metabolic rate and physical activity. Logistic regression analyses were used to investigate the association between sex-specific quartile groups (Q1–Q4) of EIEB and depression after adjusting for socioeconomic status, body mass index, lifestyle factors, and underlying diseases. @*Results@#Women in Q3 of EIEB (211–669 kcal) had a significantly lower risk of depression (odd ratio [OR], 0.78; 95% confidence interval [CI], 0.67–0.92) than those in Q1 of EIEB (<-167 kcal). The adjusted ORs of depression were 0.87 (95% CI, 0.75–1.02) in Q2 and 0.86 (95% CI, 0.74–1.01) in Q4, with P for trend=0.030. There were no significant associations between the EIEB quartile groups and depression in men after adjusting for potential confounders (P for trend=0.564). @*Conclusion@#Our results suggested that the EIEB is negatively associated with depression in Korean women.

Perceptions on Pharmacy Students on Consumers’ Demand for Transparent Dispensing Room in Community Pharmacies

Background@# Dispensing of prescription drugs is the most important task for community pharmacists. However, the public’s satisfaction with pharmacist services is not high, and distrust due to dispensing by unqualified person and/or under unsanitary conditions led to demands for transparent dispensing room (TDR) in pharmacies. @*Objective@#This study was conducted to investigate how pharmacy students perceive pharmacists’ credibility and professional ethics in conjunction with the TDR issue. @*Methods@#A survey using 20-items questionnaire was conducted from July 12 to 20, 2019 in pharmacy students nationwide. @*Results@#Among 218 respondents, 84.1% attended pharmacy school located in the metropolitan area, 61.1% were the 3rd or 4th graders, and 81.2% had no practical training in community pharmacy. 56.2% were unaware of the TDR issue, and 66.8% agreed on the public’s demand for TDR. 68.8% disagreed that TDR was the best way to solve the problem of unqualified dispensing, while 51.9% agreed that TDR was the best way in solving unsanitary dispensing problem. Publics’ confidence level of community pharmacists was mean 5.84 (range 1-10). In a question asking how expertise and professional ethics affect pharmacist confidence, 50% said expertise was more important, 31.7% the same, and 18.3% said professional ethics was more important. @*Conclusions@#To overcome the demand for TDR which began with public distrust in pharmacists, it is necessary to seek measures to increase the credibility of pharmacists, and as part of this, pharmacist ethics should be systematically educated at pharmacy school.

Effects of sevoflurane on metalloproteinase and natural killer group 2, member D (NKG2D) ligand expression and natural killer cell-mediated cytotoxicity in breast cancer: an in vitro study / 대한마취과학회지

Background@#We investigated the effects of sevoflurane exposure on the expression of matrix metalloproteinase (MMP), expression and ablation of natural killer group 2, member D (NKG2D) ligands (UL16-binding proteins 1–3 and major histocompatibility complex class I chain-related molecules A/B), and natural killer (NK) cell-mediated cytotoxicity in breast cancer cells. @*Methods@#Three human breast cancer cell lines (MCF-7, MDA-MB-453, and HCC-70) were incubated with 0 (control), 600 (S6), or 1200 μM (S12) sevoflurane for 4 h. The gene expression of NKG2D ligands and their protein expression on cancer cell surfaces were measured using multiplex polymerase chain reaction (PCR) and flow cytometry, respectively. Protein expression of MMP-1 and -2 and the concentration of soluble NKG2D ligands were analyzed using western blotting and enzyme-linked immunosorbent assays, respectively. @*Results@#Sevoflurane downregulated the mRNA and protein expression of the NKG2D ligand in a dose-dependent manner in MCF-7, MDA-MB-453, and HCC-70 cells but did not affect the expression of MMP-1 or -2 or the concentration of soluble NKG2D ligands in the MCF-7, MDA-MB-453, and HCC-70 cells. Sevoflurane attenuated NK cell-mediated cancer cell lysis in a dose-dependent manner in MCF-7, MDA-MB-453, and HCC-70 cells (P = 0.040, P = 0.040, and P = 0.040, respectively). @*Conclusions@#Our results demonstrate that sevoflurane exposure attenuates NK cell-mediated cytotoxicity in breast cancer cells in a dose-dependent manner. This could be attributed to a sevoflurane-induced decrease in the transcription of NKG2D ligands rather than sevoflurane-induced changes in MMP expression and their proteolytic activity.

Lipid emulsion inhibits the cardiac toxicity caused by chloroquine via inhibition of reactive oxygen species production / 대한마취과학회지

Background@#Lipid emulsion (LE) is effective in treating intractable cardiac depression induced by the toxicity of highly lipid-soluble drugs including local anesthetics. However, the effect of LE on chloroquine (CQ)-evoked cardiac toxicity remains unclear. This study aimed to examine the effect of Lipofundin MCT/LCT, an LE, on the cardiotoxicity caused by CQ in H9c2 rat cardiomyoblasts and elucidate the underlying cellular mechanism. @*Methods@#The effects of CQ (1 × 10-4 M), LE, and the reactive oxygen species (ROS) scavengers mitotempo and N-acetyl-L-cysteine (NAC), alone or combined, on cell viability and migration, apoptosis, ROS production, calcium levels, mitochondrial membrane potential, and adenosine triphosphate (ATP) were examined. Additionally, the effects of LE on the activities of catalase (CAT), malondialdehyde (MDA), and superoxide dismutase (SOD) induced by CQ were assessed. @*Results@#Pretreatment with LE, mitotempo, or NAC reversed the reduction in cell migration and viability, mitochondrial membrane potential, and ATP levels evoked by CQ, and inhibited the increase in cleaved caspase-3, ROS, and calcium concentration induced by CQ. LE inhibited the increase in Bax expression, terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells, MDA activity, and late apoptosis, and reversed the reduction in SOD and CAT activity induced by CQ. CQ did not significantly affect cleaved caspase-8 expression, and LE did not significantly affect CQ concentration. @*Conclusions@#Collectively, these results suggest that LE (Lipofundin MCT/LCT) inhibits the cardiotoxicity and late apoptosis induced by CQ toxicity via the intrinsic mitochondrial apoptotic pathway that is associated with direct inhibition of ROS production.

Prognostic and Safety Implications of Renin-Angiotensin-Aldosterone System Inhibitors in Hypertrophic Cardiomyopathy: A Real-World Observation Over 2,000 Patients

Background and Objectives@#The prognostic or safety implication of renin-angiotensinaldosterone system inhibitors (RASi) in hypertrophic cardiomyopathy (HCM) are not well established, mainly due to concerns regarding left ventricular outflow tract (LVOT) obstruction aggravation. We investigated the implications of RASi in a sizable number of HCM patients. @*Methods@#We enrolled 2,104 consecutive patients diagnosed with HCM in 2 tertiary university hospitals and followed up for five years. RASi use was defined as the administration of RASi after diagnostic confirmation of HCM. The primary and secondary outcomes were all-cause mortality and hospitalization for heart failure (HHF). @*Results@#RASi were prescribed to 762 patients (36.2%). During a median follow-up of 48.1months, 112 patients (5.3%) died, and 94 patients (4.5%) experienced HHF. Patients using RASi had less favorable baseline characteristics than those not using RASi, such as older age, more frequent history of comorbidities, and lower ejection fraction. Nonetheless, there was no difference in clinical outcomes between patients with and without RASi use (log-rank p=0.368 for all-cause mortality and log-rank p=0.443 for HHF). In multivariable analysis, patients taking RASi showed a comparable risk of all-cause mortality (hazard ratio [HR], 0.70, 95% confidence interval [CI], 0.43–1.14, p=0.150) and HHF (HR, 1.03, 95% CI, 0.63–1.70, p=0.900). In the subgroup analysis, there was no significant interaction of RASi use between subgroups stratified by LVOT obstruction, left ventricular (LV) ejection fraction, or maximal LV wall thickness. @*Conclusions@#RASi use was not associated with worse clinical outcomes. It might be safely administered in patients with HCM if clinically indicated.