Survival rates for invasive cutaneous malignant melanoma in South Korea in accordance with the Eighth edition AJCC Cancer Staging Manual: A retrospective single center study.

Background Cutaneous malignant melanoma is known to have a poorer prognosis in Asian patients as compared to Caucasians. Few studies have analysed the overall survival rate (OS) and melanoma-specific survival rate (MSS) of patients with cutaneous malignant melanoma in South Korea. Aim This study aims to analyse the OS, MSS and prognostic factors of patients with invasive cutaneous malignant melanoma in South Korea. Methods The medical records of patients diagnosed with invasive cutaneous malignant melanoma from July 2006 to June 2016 at Kyungpook National University Hospital were reviewed retrospectively. The OS/MSS of these patients were calculated in accordance with the Eighth American Joint Committee on Center staging system and the prognostic factors affecting MSS were analysed. Results A total of 202 patients with a mean age of 61.5 years were included. The 5-year OS/MSS was 64.4%/70.7% in the patients. The 5-year OS/MSS was 94.7%/97.1% for stage I, 67.2%/76.3% for stage II, 54.4%/59.1% for stage III, and 0%/0% for stage IV. On univariate analysis, the age, sex, Breslow thickness, ulceration, microsatellites, satellites, locally recurrent or in-transit metastasis, tumour metastasis in sentinel lymph nodes and clinicopathological stage were all significantly associated with the MSS, but not with acral distribution or BRAF mutation status. However, on multivariate analysis only the Breslow thickness, ulceration and stage IV were significantly associated with the MSS. Limitations This study was conducted retrospectively in a relatively small number of patients at a single tertiary center in South Korea. Conclusions The OS/MSS of patients with invasive cutaneous malignant melanoma in South Korea was lower than those in Caucasians. In addition to the Breslow thickness and ulceration, the impact of tumour location and sentinel nodal metastasis on cutaneous malignant melanoma should be reevaluated to better understand the disease prognosis in these patients.

Revisiting the Mesenchymal "Stem vs. Stromal" Cell Dichotomy and Its Implications for Development of Improved Potency Metrics.

Mesenchymal stem/stromal cell (MSC)-based therapies have been evaluated in over 1500 human clinical trials for a diverse array of disease indication, but outcomes remain unpredictable due to knowledge gaps in the quality attributes that confer therapeutic potency onto cells and their mode of action in vivo. Based on accumulated evidence from pre-clinical models, MSCs exert therapeutic effects by repressing inflammatory and immune-mediated response via paracrine action following reprogramming by the host injury microenvironment, and by polarization of tissue resident macrophages following phagocytosis to an alternatively activated (M2) state. An important tenet of this existing paradigm is that well-established stem/progenitor functions of MSCs are independent of paracrine function and dispensable for their anti-inflammatory and immune suppressive functions. Herein, we review evidence that stem/progenitor and paracrine functions of MSCs are mechanistically linked and organized hierarchically and describe how this link may be exploited to develop metrics that predict MSC potency across a spectrum of activities and regenerative medicine applications.

Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics: Second Revision.

BACKGROUND: The purpose of educational recommendations is to assist in establishing courses and programs in a discipline, to further develop existing educational activities in the various nations, and to support international initiatives for collaboration and sharing of courseware. The International Medical Informatics Association (IMIA) has published two versions of its international recommendations in biomedical and health informatics (BMHI) education, initially in 2000 and revised in 2010. Given the recent changes to the science, technology, the needs of the healthcare systems, and the workforce of BMHI, a revision of the recommendations is necessary. OBJECTIVE: The aim of these updated recommendations is to support educators in developing BMHI curricula at different education levels, to identify essential skills and competencies for certification of healthcare professionals and those working in the field of BMHI, to provide a tool for evaluators of academic BMHI programs to compare and accredit the quality of delivered programs, and to motivate universities, organizations, and health authorities to recognize the need for establishing and further developing BMHI educational programs. METHOD: An IMIA taskforce, established in 2017, updated the recommendations. The taskforce included representatives from all IMIA regions, with several having been involved in the development of the previous version. Workshops were held at different IMIA conferences, and an international Delphi study was performed to collect expert input on new and revised competencies. RESULTS: Recommendations are provided for courses/course tracks in BMHI as part of educational programs in biomedical and health sciences, health information management, and informatics/computer science, as well as for dedicated programs in BMHI (leading to bachelor's, master's, or doctoral degree). The educational needs are described for the roles of BMHI user, BMHI generalist, and BMHI specialist across six domain areas - BMHI core principles; health sciences and services; computer, data and information sciences; social and behavioral sciences; management science; and BMHI specialization. Furthermore, recommendations are provided for dedicated educational programs in BMHI at the level of bachelor's, master's, and doctoral degrees. These are the mainstream academic programs in BMHI. In addition, recommendations for continuing education, certification, and accreditation procedures are provided. CONCLUSION: The IMIA recommendations reflect societal changes related to globalization, digitalization, and digital transformation in general and in healthcare specifically, and center on educational needs for the healthcare workforce, computer scientists, and decision makers to acquire BMHI knowledge and skills at various levels. To support education in BMHI, IMIA offers accreditation of quality BMHI education programs. It supports information exchange on programs and courses in BMHI through its Working Group on Health and Medical Informatics Education.

Maf1 is an intrinsic suppressor against spontaneous neural repair and functional recovery after ischemic stroke.

INTRODUCTION: Spontaneous recovery after CNS injury is often very limited and incomplete, leaving most stroke patients with permanent disability. Maf1 is known as a key growth suppressor in proliferating cells. However, its role in neuronal cells after stroke remains unclear. OBJECTIVE: We aimed to investigate the mechanistic role of Maf1 in spontaneous neural repair and evaluated the therapeutic effect of targeting Maf1 on stroke recovery. METHODS: We used mouse primary neurons to determine the signaling mechanism of Maf1, and the cleavage-under-targets-and-tagmentation-sequencing to map the whole-genome promoter binding sites of Maf1 in isolated mature cortical neurons. Photothrombotic stroke model was used to determine the therapeutic effect on neural repair and functional recovery by AAV-mediated Maf1 knockdown. RESULTS: We found that Maf1 mediates mTOR signaling to regulate RNA polymerase III (Pol III)-dependent rRNA and tRNA transcription in mouse cortical neurons. mTOR regulates neuronal Maf1 phosphorylation and subcellular localization. Maf1 knockdown significantly increases Pol III transcription, neurite outgrowth and dendritic spine formation in neurons. Conversely, Maf1 overexpression suppresses such activities. In response to photothrombotic stroke in mice, Maf1 expression is increased and accumulates in the nucleus of neurons in the peripheral region of infarcted cortex, which is the key region for neural remodeling and repair during spontaneous recovery. Intriguingly, Maf1 knockdown in the peri-infarct cortex significantly enhances neural plasticity and functional recovery. Mechanistically, Maf1 not only interacts with the promoters and represses Pol III-transcribed genes, but also those of CREB-associated genes that are critical for promoting plasticity during neurodevelopment and neural repair. CONCLUSION: These findings indicate Maf1 as an intrinsic neural repair suppressor against regenerative capability of mature CNS neurons, and suggest that Maf1 is a potential therapeutic target for enhancing functional recovery after ischemic stroke and other CNS injuries.

Aspiration Pneumonia in Preterm Infants on Oral Feeds after Aspiration is Confirmed by VFSS: Case Series / 대한연하장애학회지

Premature infants often face oral feeding problems. The videofluoroscopic swallow study (VFSS) is a commonly used method to detect subglottic aspiration. However, there is no consensus to date regarding the association of aspiration observed on VFSS and incidence of aspiration pneumonia in preterm infants. This study investigated the occurrence of aspiration pneumonia in preterm infants on oral feeds after aspiration has been confirmed by VFSS. This study included 50 preterm infants who had undergone VFSS. Among them, 13 patients with no aspiration, two patients who were lost to follow-up, and nine patients with massive aspiration were excluded from the analysis. In VFSS, the frequency and amount of aspiration, nasal penetration, suck-swallow ratio, and sucking power were assessed. We analyzed 26 patients with aspiration confirmed on VFSS but who had initiated oral feeding. The frequency of aspiration (percentage of the number of aspirations to the total number of swallowing) was 10.22±3.62 (%). The mean amount of aspiration was 2.28±1.02 (%). One preterm infant, born with very low-birthweight developed aspiration pneumonia 10days after the initiation of full oral feeding. He was diagnosed with respiratory distress syndrome and had weak sucking power. In the absence of massive aspiration, most infants with aspiration confirmed on VFSS tolerated oral feeding, especially when oral feeding was partially initiated.

Association Between Air Pollution and Viral Infection in Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background@#Respiratory pathogen infections and air pollution are main causes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Air pollution has a direct effect on the airway epithelial barrier and the immune system, which can have an influence on infection. However, studies on the relationship between respiratory infections and air pollutants in severe AECOPD are limited. Thus, the objective of this study was to investigate the correlation between air pollution and respiratory pathogen in severe AECOPD. @*Methods@#This multicenter observational study was conducted by reviewing electronic medical records of patients with AECOPD at 28 hospitals in South Korea. Patients were divided into four groups according to the comprehensive air-quality index (CAI) used in Korea. Identification rates of bacteria and viruses of each group were analyzed. @*Results@#Viral pathogens were identified in 270 (36.7%) of 735 patients. Viral identification rate was different (P = 0.012) according to air pollution. Specifically, the virus detection rate was 55.9% in the group of CAI ‘D’ with the highest air pollution. It was 24.4% in the group of CAI ‘A’ with the lowest air pollution. This pattern was clearly seen for influenza virus A (P = 0.042). When further analysis was performed with particulate matter (PM), the higher/lower the PM level, the higher/lower the virus detection rate. However, no significant difference was found in the analysis related to bacteria. @*Conclusion@#Air pollution may make COPD patients more susceptible to respiratory viral infections, especially influenza virus A. Thus, on days with poor air quality, COPD patients need to be more careful about respiratory infections.

Spinal Cord Injury Fact Sheet in Korea

Spinal cord injury (SCI) has been recognized as a medically complex and life-disrupting condition. As the aging of the population accelerates, the trend of SCI has changed. This review aimed to provide comprehensive statistics and recent epidemiological changes in SCI and rehabilitation in Korea. All three insurance databases (National Health Insurance Service [NHIS], automobile insurance [AUI], and industrial accident compensation insurance [IACI]) were considered. These nationwide databases provide data on the current trends in term of incidence, etiology, and rehabilitation of SCI. Traumatic spinal cord injury (TSCI) was more frequent among the elderly in the NHIS compared to working age individuals in the AUI and IACI. In all three trauma-related insurance databases, male with TSCI outnumbered female. TSCI incidence per year was approximately 17 times higher among males than females, on average, in IACI. In all three insurances, the cervical level of TSCI was the most frequent. Although the ratio of SCI patients receiving rehabilitation treatment at primary and secondary hospitals increased for nine years, the increase in training on activities of daily living (ADL training) was found to be relatively small. This review provides a broader and comprehensive understanding of the incidence, etiology, and rehabilitation treatment of SCI in Korea.

Definitions of Chronic Obstructive Pulmonary Disease and Chronic Obstructive Pulmonary Disease Exacerbation: A Modified Delphi Survey / 결핵및호흡기질환

Background@#The Global Initiative for Chronic Obstructive Lung Disease (GOLD) update 2023 proposed new definitions of chronic obstructive pulmonary disease (COPD) and COPD exacerbation. However, an agreement on the definitions has not been made, either internationally or domestically. This study aimed to reach an agreement between experts on the new definitions of COPD and COPD exacerbation in South Korea. @*Methods@#A modified Delphi method was used to make an agreement on the definitions of COPD and COPD exacerbation proposed by the GOLD update 2023. We performed two rounds of the survey including 15 Korean experts on COPD, asthma, and tuberculosis. @*Results@#More than two-thirds of the experts agreed on 12 of the 13 statements related to the definitions of COPD and COPD exacerbation in the two rounds of the survey. The experts agreed on the definitions of COPD and COPD exacerbation that should be revised in line with the definitions proposed by the GOLD update 2023. However, the experts showed an uncertain opinion on the statement that the definition of COPD includes patients with persistent airflow obstruction due to bronchiectasis. @*Conclusion@#Based on this Delphi survey, experts’ agreement was made on the definitions of COPD and COPD exacerbation proposed by the GOLD update 2023.

The Influence of Life Stress and Sleep Disturbance on White Matter Integrity

Objective@#This study investigated whether sleep and stress mutually interact to induce changes in white matter integrity. @*Methods@#Diffusion tensor imaging (DTI) was conducted on 36 participants (male=22, female=14; mean age=38.33±12.78 years). Participants were divided into three groups depending on their sleep quality and stress levels: poor sleepers with stress, poor sleepers without stress, and good sleepers. Sleep quality and stress level were evaluated using the Pittsburgh Sleep Quality Index and the Life Experiences Survey, respectively. Fractional anisotropy (FA) values were calculated employing DTI tractography. @*Results@#After controlling for age and sex, poor sleepers with stress exhibited a lower FA of the left inferior cerebellar peduncle (ICP) than did poor sleepers without stress (t=2.81, p=0.02). Poor sleepers without stress showed a higher FA of the right middle longitudinal fasciculus (MdLF) than did good sleepers (t=3.35, p=0.006). @*Conclusion@#The current study reports the effects of sleep, stress, and their interaction on the white matter integrities of the ICP and MdLF. ICP change seems to be associated with sleep disturbances related to stress, while MdLF change would be associated with sleep disturbances unrelated to stress.

Cluster Analysis on the Mental Health States in a Community Sample of Young Women During Pre-Pregnancy, Pregnancy, or the Postpartum Period

Objective@#It is necessary to identify the mental health types of young women considering the importance of the mental health during the peripartum period. This study aimed to classify the mental health types in a community sample of young women with pre-pregnancy, pregnancy, or the postpartum period. @*Methods@#A total of 293 young women during pre-pregnancy, pregnancy, or the postpartum period were included in this study. The clinical characteristics of depression, anxiety, perceived stress, and quality of life were assessed. The clinical characteristics of the subject were classified by cluster analysis and compared by analysis of variance. @*Results@#From the cluster analysis, the subjects were classified into three groups. Cluster 1 showed significantly lower depression and anxiety and higher quality of life than those of cluster 2 and 3. Cluster 2 demonstrated significantly higher depression and anxiety and lower quality of life than those of cluster 3 and 1. Cluster 3 represented the intermediate levels between cluster 2 and 1. @*Conclusion@#This study suggested that young women during pre-pregnancy, pregnancy, or the postpartum period might be in a good mental health group, a high-risk group requiring active monitoring, or a group in need of treatment. By monitoring mental health, the groups with high risk or requiring treatment could be discovered and proper management for prevention or improvement of mental health and quality of life can be provided.

Safety and Efficacy of Intravenous Thrombolysis in the 3- to 4.5-hour Window in Acute Ischemic Stroke Patients Who Have Both Diabetes Mellitus and History of Prior Stroke

Background@#For acute ischemic stroke (AIS) patients with history of prior stroke (PS) and diabetes mellitus (DM), intravenous recombinant tissue plasminogen activator (IV-tPA) therapy in the 3- to 4.5-hour window is off-label in Korea. This study aimed to assess the safety and efficacy of IV-tPA in these patients. @*Methods@#Using data from a prospective multicenter stroke registry between January 2009 and March 2021, we identified AIS patients who received IV-tPA in the 3- to 4.5-hour window, and compared the outcomes of symptomatic intracranial hemorrhage (SICH), 3-month mortality, 3-month modified Rankin Scale (mRS) score 0-1 and 3-month mRS distribution between patients with both PS and DM (PS/DM, n=56) versus those with neither PS nor DM, or with only one (non-PS/DM, n=927). @*Results@#The PS/DM group versus the non-PS/DM group was more likely to have a prior disability, hypertension, hyperlipidemia, coronary heart disease and less likely to have atrial fibrillation. The PS/DM and the non-PS/DM groups had comparable rates of SICH (0% vs. 1.7%; p>0.999) and 3-month mortality (10.7% vs. 10.2%; p=0.9112). The rate of 3-month mRS 0-1 was non-significantly lower in the PS/DM group than in the non-PS/DM group (30.4% vs. 40.7%; adjusted odds ratio [95% confidence interval], 0.81 [0.41-1.59]). @*Conclusions@#In the 3- to 4.5-hour window, AIS patients with PS/DM, as compared to those with non-PS/DM, might benefit less from IV-tPA. However, given the similar risks of SICH and mortality, IV-tPA in the late time window could be considered in patients with both PS and DM.

Coinfection of Severe Fever With Thrombocytopenia Syndrome Virus and Coxiella burnetii in Developmental Stage of Hard Ticks in Subtropical Region of Korea

Background@#Severe fever with thrombocytopenia syndrome virus (SFTSV) is transmitted through tick bites. Ticks are potential vectors for the bacterium Coxiella burnetii that causes Query fever. Here, we analyzed SFTSV and C. burnetii co-infection rates in ticks in rural areas of Jeju Island, South Korea. @*Methods@#Free ticks were collected from the natural environment of the island between 2016 and 2019, and SFTSV RNA was extracted. Additionally, ribosomal RNA gene sequencing was used to identify Coxiella species. @*Results@#Haemaphysalis longicornis was the most common tick species followed by H. flava. Tick number gradually increased from April, peaked in August, and was lowest in March. Of all the collected ticks, 82.6% (2,851/3,458) were nymphs, 17.9% (639/3,458) adults, and 0.1% (4/3,458) larvae. SFTSV-infected ticks comprised 12.6% of all ticks; their numbers were the lowest in November–December, increased from January, and were mostly identified in the adult stage during June–August. C. burnetii infections were detected in 4.4% of the SFTSVinfected H. longicornis ticks. C. burnetii co-infection was mainly observed in the nymph stage of H. longicornis, with the highest infection rate in January, followed by December and November. @*Conclusion@#Our findings suggest that Jeju Island has a high SFTSV and potential C. burnetii infection in ticks. This study provides important insights regarding SFTS and Q fever risk to humans in South Korea.

A Proactive Testing Strategy to COVID-19 for Reopening University Campus during Omicron Wave in Korea: Ewha Safe Campus (ESC) Project / 이화의대지

Objectives@#Ewha Womans University launched an on-campus Coronavirus disease-19 (COVID-19) response system called Ewha Safety Campus (ESC) Project in collaboration with the Seegene Inc. RTPCR diagnostic tests for COVID-19 were proactively provided to the participants. This study examines the effectiveness of the on-campus testing strategy in controlling the reproduction number (Rt ) and identifying student groups vulnerable to infection. @*Methods@#The ESC project was launched on March 2, 2022, with a pilot period from Feb 22 to March 1, 2022—the peak of the Omicron variant wave. We collected daily data on the RT-PCR test results of the students of Ewha Womans University from Mar 2 to Apr 30, 2022. We daily calculated Rt and compared it with that of the general population of Korea (women, people aged 20–29 years, and Seoul residents). We also examined the students vulnerable to the infection based on the group-specific Rt and positivity rate. @*Results@#A lower Rt was observed about 2 weeks after the implementation of the ESC Project than that of the general population. The lower Rt persisted during the entire study period. Dormitory residents had a higher Rt . The positivity rate was higher in students who did not comply with quarantine guidelines and did not receive the second dose of the vaccine. @*Conclusion@#The study provides scientific evidence for the effectiveness of the on-campus testing strategy and different infection vulnerabilities of students, depending on dormitory residence, compliance with the quarantine guidelines, and vaccination.

Omega-3 fatty acids upregulate Nrf2 expression and attenuate apoptosis, inflammation, and fibrosis in a rat model of cyclosporine-induced nephropathy / 고신대학교의과대학학술지

Background@#Cyclosporine A (CsA)-induced kidney injury is characterized by renal impairment with inflammatory cell infiltrations, apoptosis, fibrosis, and hypoxic injury. It is not clear whether omega-3 fatty acids (O-3 FAs), which have anti-inflammatory and antioxidant roles, affect nuclear factor erythroid 2-related factor 2 (Nrf2) expression. The aim of this study was to investigate whether O-3 FAs affect Nrf2 expression and exert anti-inflammatory, anti-apoptotic, and anti-fibrotic effects in CsA-induced nephropathy. @*Methods@#Male Sprague-Dawley rats were divided into control, CsA-treated, and CsA-treated with O-3 FA groups. Nrf2 expression was measured by Western blots and immunohistochemical staining. @*Results@#Kidney function was impaired in the CsA-treated rats compared to the controls. Caspase-3 and caspase-7 were activated in the CsA-treated group, and the Bax/Bcl2 ratio was higher. O-3 FAs attenuated these apoptosis-related changes. ED-1 and inhibition of kappa B (IĸB) protein expression were significantly upregulated in the CsA-treated group. Compared to the control group, O-3 FA supplementation attenuated the increased expression of ED-1 and IĸB related to inflammation. Smad2/3, Smad4, and transforming growth factor-β1 were activated in the CsA group, and O-3 FA treatment prevented these changes related to renal fibrosis. The expression of Nrf2 was reduced in CsA-treated rats, but Nrf-2 was increased by O-3 FA treatment. @*Conclusions@#We suggest that Nrf2 is a potential mediator induced by O-3 FA supplementation and that it attenuates pro-inflammatory pathways, fibrotic processes, and apoptosis. Further studies are needed to elucidate the crosstalk between Nrf2 expression and signals related to O-3 FA treatment.

Treatment of upper and lower 3D printing CAD-CAM dentures using the POP (PNUD Occlusal Plane) Bow system, a prefabricated occlusal plane transfer device: A case report / 대한치과보철학회지

In order to manufacture functional and esthetic prostheses, it is essential to accurately transmit information about the patient’s occlusal plane. In particular, in the case of a completely edentulous patient, the occlusal plane is very important to correctly support the soft tissue, to achieve aesthetic harmony with the facial appearance, and to properly pronounce it, and to form a balanced occlusal relationship for stable mastication. In the conventional method, various facebow systems were used to transmit patient’s information from the clinic to the laboratory, but there were several limitations in the process of transferring them to CAD. To simplify this process, a prefabricated POP (PNUD Occlusal Plane) Bow system was recently developed. In this case, a CAD-CAM (Computer-aided design-computer-aided manufacturing) treatment dentures reflecting the patient’s occlusal plane information was manufactured using the POP Bow system during the treatment of a completely edentulous patient, and aesthetic and functional satisfaction was obtained.

Association between inflammation-based prognostic markers and mortality of non-cardiac surgery / 대한마취과학회지

Background@#To evaluate the association between inflammation and nutrition-based biomarkers and postoperative outcomes after non-cardiac surgery. @*Methods@#Between January 2011 and June 2019, a total of 102,052 patients undergoing non-cardiac surgery were evaluated, with C-reactive protein (CRP), albumin, and complete blood count (CBC) measured within six months before surgery. We assessed their CRP-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and modified Glasgow Prognostic Score (mGPS). We determined the best cut-off values by using the receiver operating characteristic (ROC) curves. Patients were divided into high and low groups according to the estimated threshold, and we compared the one-year mortality. @*Results@#The one-year mortality of the entire sample was 4.2%. ROC analysis revealed areas under the curve of 0.796, 0.743, 0.670, and 0.708 for CAR, NLR, PLR, and mGPS, respectively. According to the estimated threshold, high CAR, NLR, PLR, and mGPS were associated with increased one-year mortality (1.7% vs. 11.7%, hazard ratio [HR]: 2.38, 95% CI [2.05, 2.76], P < 0.001 for CAR; 2.2% vs. 10.3%, HR: 1.81, 95% CI [1.62, 2.03], P < 0.001 for NLR; 2.6% vs. 10.5%, HR: 1.86, 95% CI [1.73, 2.01], P < 0.001 for PLR; and 2.3% vs. 16.3%, HR: 2.37, 95% CI [2.07, 2.72], P < 0.001 for mGPS). @*Conclusions@#Preoperative CAR, NRL, PLR, and mGPS were associated with postoperative mortality. Our findings may be helpful in predicting mortality after non-cardiac surgery.

Evaluating the Safety and effectivenesS in adult KorEaN patients treated with Tolvaptan for management ofautosomal domInAnt poLycystic kidney disease (ESSENTIAL): short-term outcomes during the titration period

Tolvaptan reduces height-adjusted total kidney volume (htTKV) and renal function decline in autosomal dominant polycystic kidney disease (ADPKD). This study was aimed at investigating the efficacy and safety of tolvaptan in Korean patients with ADPKD during the titration period. Methods: This study is a multicenter, single-arm, open-label phase 4 study. We enrolled 108 patients with ADPKD (age, 19–50 years) with an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2 and factors defined as indicative of rapid disease progression. After tolvaptan titration, we evaluated efficacy and side effects and assessed factors associated with the effects. Results: After titration for 4 weeks, eGFR and htTKV decreased by 6.4 ± 7.9 mL/min/1.73 m2 and 16 ± 45 mL/m, respectively. No serious adverse drug reactions were observed during the titration period. The greatest eGFR decline was observed in the first week, with a starting tolvaptan dose of 45 mg. Multivariate linear regression for htTKV decline showed that the greater the change in urine osmolality (Uosm), the greater the decrease in htTKV (β, 0.436; p = 0.009) in the 1D group stratified by the Mayo Clinic image classification. Higher baseline eGFR was related to a higher htTKV reduction rate in the 1E group (β, –0.642; p = 0.009). Conclusion: We observed short-term effects and safety during the tolvaptan titration period. The decline of htTKV can be predicted as a short-term effect of tolvaptan by observing Uosm changes from baseline to end of titration in 1D and baseline eGFR in 1E groups.

Generalized Tetanus Treated with Intrathecal Baclofen Infusion

Tetanus is a bacterial infection by Clostridium tetani. Its neurotoxin causes spastic paralysis and autonomic dysfunction. Intrathecal infusion of baclofen has been suggested as a pertinent treatment for generalized spasm. Our case describes a patient who had a severe generalized form of tetanus, and was effectively treated with intrathecal baclofen infusion. He showed cerebral and brainstem dysfunction during baclofen infusion, which were reversed without sequelae when baclofen was discontinued.

Survey of Public Attitudes toward the Secondary Use of Public Healthcare Data in Korea / 대한의료정보학회지

Objectives@#Public healthcare data have become crucial to the advancement of medicine, and recent changes in legal structure on privacy protection have expanded access to these data with pseudonymization. Recent debates on public healthcare data use by private insurance companies have shown large discrepancies in perceptions among the general public, healthcare professionals, private companies, and lawmakers. This study examined public attitudes toward the secondary use of public data, focusing on differences between public and private entities. @*Methods@#An online survey was conducted from January 11 to 24, 2022, involving a random sample of adults between 19 and 65 of age in 17 provinces, guided by the August 2021 census. @*Results@#The final survey analysis included 1,370 participants. Most participants were aware of health data collection (72.5%) and recent changes in legal structures (61.4%) but were reluctant to share their pseudonymized raw data (51.8%). Overall, they were favorable toward data use by public agencies but disfavored use by private entities, notably marketing and private insurance companies. Concerns were frequently noted regarding commercial use of data and data breaches. Among the respondents, 50.9% were negative about the use of public healthcare data by private insurance companies, 22.9% favored this use, and 1.9% were “very positive.” @*Conclusions@#This survey revealed a low understanding among key stakeholders regarding digital health data use, which is hindering the realization of the full potential of public healthcare data. This survey provides a basis for future policy developments and advocacy for the secondary use of health data.

Extracellular Vesicles Released by Lactobacillus paracasei Mitigate Stress-induced Transcriptional Changes and Depression-like Behavior in Mice

Various probiotic strains have been reported to affect emotional behavior. However, the underlying mechanisms by which specific probiotic strains change brain function are not clearly understood. Here, we report that extracellular vesicles derived from Lactobacillus paracasei (Lpc-EV) have an ability to produce genome-wide changes against glucocorticoid (GC)-induced transcriptional responses in HT22 hippocampal neuronal cells. Genome-wide analysis using microarray assay followed by Rank-Rank Hypergeometric Overlap (RRHO) method leads to identify the top 20%-ranked 1,754 genes up- or down-regulated following GC treatment and their altered expressions are reversed by Lpc-EV in HT22 cells. Serial k-means clustering combined with Gene Ontology enrichment analyses indicate that the identified genes can be grouped into multiple functional clusters that contain functional modules of “responses to stress or steroid hormones”, “histone modification”, and “regulating MAPK signaling pathways”. While all the selected genes respond to GC and Lpc-EV at certain levels, the present study focuses on the clusters that contain Mkp-1, Fkbp5, and Mecp2, the genes characterized to respond to GC and Lpc-EV in opposite directions in HT22 cells. A translational study indicates that the expression levels of Mkp-1, Fkbp5, and Mecp2 are changed in the hippocampus of mice exposed to chronic stress in the same directions as those following GC treatment in HT22 cells, whereas Lpc-EV treatment restored stress-induced changes of those factors, and alleviated stress-induced depressive-like behavior. These results suggest that Lpc-EV cargo contains bioactive components that directly induce genome-wide transcriptional responses against GC-induced transcriptional and behavioral changes.