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Objectives@#This study examined the adoption and utilization of personal health records (PHR) across Korean medical institutions using data from the 2020 National Health and Medical Informatization Survey. @*Methods@#Spearheaded by the Ministry of Health and Welfare and prominent academic societies, this study surveyed PHR utilization in 574 medical institutions. @*Results@#Among these institutions, 84.9% (487 hospitals) maintained medical portals. However, just 14.1% (81 hospitals) had web-based or mobile PHRs, with 66.7% (28 of 42) of tertiary care hospitals adopting them. Tertiary hospitals led in PHR services: 87.8% offered certification issuance, 51.2% provided educational information, 63.4% supported online payment, and 95.1% managed appointment reservations. In contrast, general and smaller hospitals had lower rates. Online medical information viewing was prominent in tertiary hospitals (64.3%). Most patients accessed test results via PHRs, but other data types were less frequent, and only a few allowed downloads. Despite the widespread access to medical data through PHRs, integration with wearables and biometric data transfers to electronic medical records remained low, with limited plans for expansion in the coming three years. @*Conclusions@#Approximately two-thirds of the surveyed medical institutions provided PHRs, but hospitals and clinics in charge of community care had very limited PHR implementation. Government-led leadership is required to invigorate the use of PHRs in medical institutions.
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Background@#Hepatic stellate cells (HSCs) are the major cells which play a pivotal role in liver fibrosis. During injury, extracellular stimulators can induce HSCs transdifferentiated into active form. Phloretin showed its ability to protect the liver from injury, so in this research we would like to investigate the effect of phloretin on succinate-induced HSCs activation in vitro and liver fibrosis in vivo study. @*Methods@#In in vitro, succinate was used to induce HSCs activation, and then the effect of phloretin on activated HSCs was examined. In in vivo, succinate was used to generated liver fibrosis in mouse and phloretin co-treated to check its protection on the liver. @*Results@#Phloretin can reduce the increase of fibrogenic markers and inhibits the proliferation, migration, and contraction caused by succinate in in vitro experiments. Moreover, an upregulation of proteins associated with aerobic glycolysis occurred during the activation of HSCs, which was attenuated by phloretin treatment. In in vivo experiments, intraperitoneal injection of phloretin decreased expression of fibrotic and glycolytic markers in the livers of mice with sodium succinate diet-induced liver fibrosis. These results suggest that aerobic glycolysis plays critical role in activation of HSCs and succinate can induce liver fibrosis in mice, whereas phloretin has therapeutic potential for treating hepatic fibrosis. @*Conclusion@#Intraperitoneal injection of phloretin attenuated succinate-induced hepatic fibrosis and alleviates the succinate-induced HSCs activation.
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Background@#Despite increased clinical and research interest in sarcopenia, even in Asia, not much is known about the association between sarcopenia and depressive symptoms. Sarcopenia and depressive symptoms are associated with several health problems in older adults; therefore, we investigated the association between sarcopenia and depression in Korean older adults. @*Methods@#The study sample included 1,929 participants aged over 60 years (44.6% men; mean age, 69.7 years) from nationally representative data of the 2018 Korea National Health and Nutrition Examination survey. Possible sarcopenia was defined according to the diagnostic algorithm of the Asian Working Group for Sarcopenia 2019; however, we measured only hand-grip strength (kg) in this study. Patient Health Questionnaire-9 was used for screening for symptoms of depression. A cross-sectional analysis was used to examine the relationship between possible sarcopenia and depressive symptoms. @*Results@#Possible sarcopenia and depressive symptoms were identified in 538 (27.9%) and 97 (5.0%) participants, respectively. After adjusting for age, sex, and other potential covariates, possible sarcopenia was positively associated with higher odds of depressive symptoms (odds ratio, 2.06; 95% confidence interval, 1.36–3.11; P<0.001). @*Conclusion@#Possible sarcopenia was significantly associated with depressive symptoms in Korean older adults. Early interventions for possible sarcopenia and depressive symptoms in routine clinical practice could help Korean older adults to have healthy aging. Future studies are required to explore any causal relationship between possible sarcopenia and depressive symptoms in Korean older adults.
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Background@#The angular stable locking system (ASLS) was developed to provide additional stability to the distal interlocking screw of the intramedullary (IM) nail. Effects of ASLS on the treatment of femoral diaphyseal fractures in the elderly remain unknown. The aim of this study was to compare radiological outcomes of IM nailing using ASLS screws to IM nails with conventional interlocking screws in elderly patients with femoral shaft fractures. @*Methods@#A multicenter retrospective review of 129 patients (average age, 73.5 years; 98 women and 31 men) aged 65 years or older who underwent IM nail fixation for femoral diaphyseal fractures (AO/Orthopaedic Trauma Association [OTA] classification 32) was conducted. Demographic information of patients, fracture site (subtrochanteric or shaft), fracture type (traumatic or atypical), and AO/OTA fracture classification were investigated. Reduction status was evaluated by postoperative plain radiography. Presence of union and time to union were evaluated through serial plain radiograph follow-up. Reoperation due to nonunion or implant failure was also evaluated. @*Results@#ASLS was used in 65 patients (50.3%). A total of 118 patients (91.5%) achieved union without additional surgery and the mean union time was 31.8 ± 13.0 weeks. In terms of reduction status, angulation was greater in the group using ASLS. There were no statistically significant differences of union rate, time to union, and reoperation rate according to the use of ASLS (p > 0.05). There was no difference in the outcomes according to the use of ASLS even when the analysis was divided in terms of fracture site or fracture type (p > 0.05). In further subgroup analysis, only the traumatic subtrochanteric area group showed statistically significantly shorter time to union when ASLS was used (p = 0.038). @*Conclusions@#In geriatric patients with femoral diaphyseal fractures, the use of ASLS was not considered to have a significant effect on fracture healing. Fracture healing seemed to be more affected by surgical techniques such as minimizing the gap and fracture characteristics such as atypical femoral fractures, rather than implants.
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Syringocystadenoma papilliferum (SCAP) and apocrine hidrocystoma (AH) are benign apocrine neoplasms that usually occur separately. SCAP arises predominantly in head and neck, while AH typically develop in periorbital area. We report a case of a 68-year-old male with an asymptomatic erythematous papulonodule that occurred on his back 3 years ago. Histologic examination showed cystic invagination extending from the epidermis into the dermis with some papillary projections. The invaginated portion was lined by epithelial bilayer composed of cuboidal and columnar cells, and decapitation secretion was observed in the inner epithelial layer. In the deep dermis, multiple cystic spaces with variable sizes were observed, and these cysts also presented double layers of the epithelium and decapitation secretion.According to such histologic features, the coexistence of SCAP and AH within a single lesion was demonstrated. The patient was recommended to completely remove the remaining lesion after punch biopsy, but he refused further surgical management. Herein, we report an unusual case of complex apocrine tumor with a rare composition in an atypical site.
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In reproduction, mitochondria produce bioenergy, help to synthesize biomolecules, and support the ovaries, oogenesis, and preimplantation embryos, thereby facilitating healthy live births. However, the regulatory mechanism of mitochondria in oocytes and embryos during oogenesis and embryo development has not been clearly elucidated. The functional activity of mitochondria is crucial for determining the quality of oocytes and embryos; therefore, the underlying mechanism must be better understood. In this review, we summarize the specific role of mitochondria in reproduction in oocytes and embryos. We also briefly discuss the recovery of mitochondrial function in gametes and zygotes. First, we introduce the general characteristics of mitochondria in cells, including their roles in adenosine triphosphate and reactive oxygen species production, calcium homeostasis, and programmed cell death. Second, we present the unique characteristics of mitochondria in female reproduction, covering the bottleneck theory, mitochondrial shape, and mitochondrial metabolic pathways during oogenesis and preimplantation embryo development. Mitochondrial dysfunction is associated with ovarian aging, a diminished ovarian reserve, a poor ovarian response, and several reproduction problems in gametes and zygotes, such as aneuploidy and genetic disorders. Finally, we briefly describe which factors are involved in mitochondrial dysfunction and how mitochondrial function can be recovered in reproduction. We hope to provide a new viewpoint regarding factors that can overcome mitochondrial dysfunction in the field of reproductive medicine.
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no abstract available.
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Background@#Polo-like kinase 4 (PLK4) is a serine/threonine protein kinase located in the centriole of the chromosome during the cell cycle. PLK4 overexpression has been described in a variety of many common human epithelial tumors. Conversely, PLK4 acts as a haploinsufficient tumor suppressor in some situations, highlighting the importance of strict regulation of PLK4 expression, activity, and function. Meanwhile, the importance of chemoradiation resistance in rectal cancer is being emphasized more than ever. We aimed to analyze PLK4 expression and the tumor regression grade (TRG) in patients with rectal cancer, treated with chemoradiotherapy (CRT). @*Methods@#A retrospective study was conducted on 102 patients with rectal cancer who received preoperative CRT. Immunohistochemistry for PLK4 in paraffin-embedded tissue was performed from the biopsy and surgical specimens. @*Results@#We found significant association between high expression of PLK4 and poor response to neoadjuvant CRT (according to both Mandard and The Korean Society of Pathologists TRG systems) in the pre-CRT specimens. Other clinicopathologic parameters did not reveal any correlation with PLK4 expression. @*Conclusions@#This study revealed an association between high expression of PLK4 in the pre-CRT specimens and TRG. Our results indicated that PLK4 could potentially be a new predictor for CRT effect in patients with rectal cancer.
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Diarylpropionitrile (DPN), a selective agonist for estrogen receptor β(ERβ), has been reported to regulate various hormonal responses through activation of ERβ in tissues including the mammary gland and brain. However, the effect of DPN on melanogenesis independent of ERβ has not been studied. The aim of this study is to examine the possibility of anti-melanogenic effect of DPN and its underlying mechanism. Melanin contents and cellular tyrosinase activity assay indicated that DPN inhibited melanin biosynthesis in alpha-melanocyte stimulating hormonestimulated B16F10 melanoma cell line. However, DPN had no direct influence on in vitro tyrosinase catalytic activity. On the other hand, 17β-estradiol had no effect on inhibition of melanogenesis, suggesting that the DPN-mediated suppression of melanin production was not related with estrogen signaling pathway. Immunoblotting analysis showed that DPN down-regulated the expression of microphthalmiaassociated transcription factor (MITF), a central transcription factor of melanogenesis and its down-stream genes including tyrosinase, tyrosinase-related protein (TRP)-1, and TRP-2. Also, DPN attenuated the phosphorylation of protein kinase A (PKA) and cAMP-response element-binding protein (CREB). Additionally, DPN suppressed the melanin synthesis in UVB-irradiated HaCaT conditioned media culture system suggesting that DPN has potential as an anti-melanogenic activity in physiological conditions. Collectively, our data show that DPN inhibits melanogenesis via downregulation of PKA/CREB/MITF signaling pathway.
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Background/Aims@#Pirfenidone slows the progression of idiopathic pulmonary fibrosis (IPF). We investigated its efficacy and safety in terms of dose and disease severity in real-world patients with IPF. @*Methods@#This multicenter retrospective cohort study investigated 338 patients treated with pirfenidone between July 2012 and March 2018. Demographics, pulmonary function, mortality, and pirfenidone-related adverse events were also investigated. Efficacy was analyzed according to pirfenidone dose and disease severity using linear mixed-effects models to assess the annual decline rate of forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO). @*Results@#The mean %FVCpredicted and %DLCOpredicted values were 72.6% ± 13.1% and 61.4% ± 17.9%, respectively. The mean duration of pirfenidone treatment was 16.1 ± 9.0 months. In the standard dose (1,800 mg/day) group, the mean %FVCpredicted was −6.56% (95% confidence interval [CI], −9.26 to −3.87) per year before, but −4.43% (95% CI, −5.87 to −3.00) per year after treatment with pirfenidone. In the non-standard lower dose group, the mean %FVCpredicted was −4.96% (95% CI, −6.82 to −3.09) per year before, but −1.79% (95% CI, −2.75 to −0.83) per year after treatment with pirfenidone. The FVC decline rate was significantly reduced, regardless of the Gender-Age-Physiology (GAP) stage. Adverse events and mortality were similar across dose groups; however, they were more frequent in GAP stages II–III than in the stage I group. @*Conclusions@#The effect of pirfenidone on reducing disease progression of IPF persisted even with a consistently lower dose of pirfenidone.
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Background@#Fever and skin eruption are common manifestations in patients; however, assessing them can be challenging because of the wide range of differential diagnosis. @*Objective@#We aimed to obtain tips that could assist in differential diagnoses in patients with fever and skin eruption through the analysis of clinical features. @*Methods@#Medical records of hospitalized patients who had fever and skin eruption were examined from January 2010 to December 2019. @*Results@#The patients of the adverse drug reaction group were older (p=0.024), and they had underlying diseases (p＜0.001), whole body skin eruption (p=0.018), elevated alanine aminotransferase (p=0.027). The autoimmune disease group was associated with longer total fever and skin eruption duration (p=0.049, 0.037), leukocytosis (p=0.015), and neutrophilia (p=0.006). Infectious erythema group was associated with targetoid lesions (p=0.003). @*Conclusion@#Clinicians should examine patients with fever and skin eruption, considering that there may be various causes. This can be assisted by delicate skin exam and laboratory tests.
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OBJECTIVES: After total knee arthroplasty (TKA), many patients experience anemia due to blood loss. To prevent postoperative anemia and allogeneic blood transfusion after TKA, we used prophylactic allogeneic or autologous blood transfusion intraoperatively. This study evaluated the effects of prophylactic transfusion during TKA. MATERIALS AND METHODS: This retrospective cohort study included 579 patients receiving scheduled unilateral TKA. We allocated the patients into three groups, the prophylactic allogeneic transfusion (Group AL), prophylactic autologous transfusion (Group AT), and no prophylactic transfusion with intra-articular tranexamic acid administration (GroupC) groups. After propensity score matching, we compared the rate of postoperative allogeneic blood transfusions until three days after TKA, postoperative hemoglobin and hematocrit levels until four days after TKA, and the side effects in each groups. RESULTS: The postoperative allogeneic blood transfusion rates were statistically higher in group AL and AT than in group C (18.2% and, 18.9% vs 2.3%, respectively; P<0.000). The postoperative hemoglobin and hematocrit levels were statistically lower in group Auto than in group C (P<0.0001), but the levels in group AL were not different from those of group C (P=0.493 vs. P=0.384 respectively). In addition, the side effects were statistically higher in group AL and AT than in group C. CONCLUSION: Prophylactic intra-operative transfusions did not reduce the rates of allogeneic transfusions and produced more side effects and hypotension after surgery than intra-articular tranexamic acid administration with no prophylactic transfusion in patients undergoing TKAs.
Subject(s)
Antifibrinolytic Agents , Arthroplasty, Replacement, Knee , Tranexamic Acid , Arthroplasty, Replacement, Knee/adverse effects , Blood Loss, Surgical/prevention & control , Blood Transfusion , Humans , Retrospective Studies , Tranexamic Acid/therapeutic useABSTRACT
The educational development in Korean Medical School has shown remarkable results in about 20 years. These institutes has an excellent evaluation base and educational independence. And the curriculum, the method, and the evaluation in medical education have been innovated over recent 20 years. Those revolutionary outcome of the innovation of medical education affirms possibilities and potentialities of innovation and reformation in the future. In response, this article attempted to reflect on the deficiencies of medical education through the analysis of the educational status of medical humanities in 40 medical schools for better future medical humanities education under such a strong environment. Therefore, the purpose of this article is to present the direction in which medical humanities literature based on value education. In this process, in order to find the essence of medical education through educational philosophy discourse, the blue print of evidence based medicine is presented, and the role and direction of medical humanities are suggested through reflection on strengthening medical education capabilities.
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Hand-foot-mouth disease (HFMD) is a viral infection that occurs commonly in children. It is characterized by vesicles with surrounding erythema on the extremities and mouth. Most common pathogens are Coxsackievirus A16 and Enterovirus 71. HFMD caused by Coxsackievirus A6 is uncommon and accompanied by more extensive and atypical eruptions. A 42-year-old man presented with erythematous papules and vesicles on the right hand which occurred 7 days prior to presentation. The rash spread extensively with high fever, chills, headache, and myalgia. He also had whitish ulcer-like lesions on the oral mucosa with swallowing difficulty. One day after hospitalization, he developed arthralgia on his shoulders, pelvis, knees, and fingers. The biopsy specimen showed an intraepidermal blister with reticular degeneration, epidermal necrosis, and neutrophilic infiltration. There were no inclusion cells or giant cells. The serum antibody titer of Coxsackievirus A6 showed a significant increase, at 64 times. He was diagnosed with HFMD caused by Coxsackievirus A6.
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Objectives@#This review article examines international examples of personal health records (PHRs) in advanced countries and discusses the implications of these examples for the establishment and utilization of PHRs in South Korea. @*Methods@#This article synthesized PHR case reports of Organization for Economic Co-operation and Development (OECD) member countries, the Global Digital Health Partnership website on PHRs, and patient portals of individual countries to review the status of PHR services. The concept and significance of PHRs were also discussed with respect to PHR utilization status in European Union and OECD countries. @*Results@#A review of international PHR services showed that the countries shared common points regarding the establishment of Electronic Health Records and national health information infrastructure. In addition, the countries provided services centered on primary healthcare institutions and public hospitals. However, promoting more positive participation and increasing the PHR acceptance rate requires workflow integration, including Electronic Medical Records, the provision of incentives, and the preparation of a supportive legal framework. @*Conclusions@#South Korea is also conducting a national-level PHR project. Since the scope of PHRs is extensive and a wide range of PHR services must be connected, an extensive trial-and-error process will be necessary. A long-term strategy should be prepared, and necessary resources should be secured to establish national-level PHRs.
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Background@#The oral administration of polystyrene-microplastics (PS-MPs) causes chronic constipation of ICR mice, but there are no reports on their effects on the inflammatory response in the colon. To determine if the oral administration of MPs causes inflammation in the colon, the changes in the apoptosis-associated speck like protein containing a caspase recruitment domain (ASC)-inflammasome pathway, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway, and inflammatory cytokine expression were evaluated in the mid colon of ICR mice treated with 0.5 μm size PS-MPs for two weeks. @*Results@#The thicknesses of the mucosa, muscle, flat luminal surface, and crypt layer were decreased significantly (p < 0.01) in the mid colon of the MPs treated group compared to the Vehicle treated group. On the other hand, a remarkable increase in the expression levels of NOD-like receptor pyrin domain-containing protein (NLRP) 3, ASC, and Cleaved Caspase (Cas)-1 protein was observed in the MPs treated group. In addition, similar increasing pattern in the levels of p-NF-κB and phospho-inhibitory subunit of NF-κB (p-IkB) α protein was detected. Four inflammatory cytokines, including NF-κB, interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β, showed an increased expression level after the MPs treatment. @*Conclusions@#Therefore, the present study suggests that PS-MPs can be a novel cause of an inflammatory response in the mid colon of ICR mice.
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Glioblastoma multiforme (GBM) is the most lethal type of brain tumor and its prognosis was extremely poor. Here, we studied the clinical and prognostic value of telomerase reverse transcriptase (TERT) and GA Binding Protein Transcription Factor Subunit Beta 1 longer (GABPB1L) mRNA expression in GBM by using open big data. In total 152 GBM patients, gene expressions were downloaded from the Cancer Genome Atlas (TCGA) data and its values were statistically analyzed. TCGA data showed that GABPB1L mRNA expression levels did not correlate with those of TERT mRNA (r = -0.027, p = 0.744). GABPB1L and TERT expressions in GBM were associated with subtype by gene expression. GABPB1L (562.7 ± 76.8 days vs. 479.1 ± 5.8 days, p = 0.401) and TERT (468.1 ± 43.6 days vs. 565.3 ± 75.8 days, p = 0.403) expression was not associated with GBM prognosis. However, disease-free survival was tended to be different in GBM patients according to TERT and GABPB1L expressions though it did not get statistical significance (2122.6 ± 160.2 days vs. 1381.1 ± 244.0 days, p = 0.072). These genes may contribute to the GBM pathogenesis and its further study should be performed in GBM patients and cell lines.
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A genetic etiology of male infertility is identified in fewer than 25% of infertile men, while 30% of infertile men lack a clear etiology, resulting in a diagnosis of idiopathic male infertility. Advances in reproductive genetics have provided insights into the mechanisms of male infertility, and a characterization of the genetic basis of male infertility may have broad implications for understanding the causes of infertility and determining the prognosis, optimal treatment, and management of couples. In a substantial proportion of patients with azoospermia, known genetic factors contribute to male infertility. Additionally, the number of identified genetic anomalies in other etiologies of male infertility is growing through advances in whole-genome amplification and next-generation sequencing. In this review, we present an up-to-date overview of the indications for appropriate genetic tests, summarize the characteristics of chromosomal and genetic diseases, and discuss the treatment of couples with genetic infertility by microdissection-testicular sperm extraction, personalized hormone therapy, and in vitro fertilization with pre-implantation genetic testing.
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Objectives@#This review article examines international examples of personal health records (PHRs) in advanced countries and discusses the implications of these examples for the establishment and utilization of PHRs in South Korea. @*Methods@#This article synthesized PHR case reports of Organization for Economic Co-operation and Development (OECD) member countries, the Global Digital Health Partnership website on PHRs, and patient portals of individual countries to review the status of PHR services. The concept and significance of PHRs were also discussed with respect to PHR utilization status in European Union and OECD countries. @*Results@#A review of international PHR services showed that the countries shared common points regarding the establishment of Electronic Health Records and national health information infrastructure. In addition, the countries provided services centered on primary healthcare institutions and public hospitals. However, promoting more positive participation and increasing the PHR acceptance rate requires workflow integration, including Electronic Medical Records, the provision of incentives, and the preparation of a supportive legal framework. @*Conclusions@#South Korea is also conducting a national-level PHR project. Since the scope of PHRs is extensive and a wide range of PHR services must be connected, an extensive trial-and-error process will be necessary. A long-term strategy should be prepared, and necessary resources should be secured to establish national-level PHRs.
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Background@#Bacterial skin soft-tissue infection is a common clinical manifestation in dermatology. The treatment of bacterial skin infections is often challenging due to antibiotic resistance, including methicillin resistance. @*Objective@#The aim of this study was to investigate the isolation rate of bacteria, antibiotic susceptibility, clinical features, and factors associated with treatment response in bacterial skin infections. @*Methods@#We retrospectively reviewed the medical records of patients who underwent ordinary bacterial skin cultures of the site of superficial skin infections between 2010 and 2019. @*Results@#A total of 1,298 patients were included in the study. The most commonly isolated bacteria were Staphylococcus aureus (31.3%), followed by coagulase-negative staphylococci (22.0%) and Pseudomonas species (4.2%). The methicillin-resistance rate of S. aureus was 22.7%. Crusted lesions (p=0.025), treatment with steroids (p=0.035), duration over 7 days (p=0.009), and isolation of Pseudomonas (p＜0.001) or other uncommon species (non-Staphylococcus, Streptococcus, and Pseudomonas species, p＜0.001) were significantly associated with treatment response. @*Conclusion@#The methicillin-resistance rate of S. aureus was similar to that of the past 5 years, but the mupirocin-resistance rate significantly increased. Lesions with crust or those that were treated with steroids showed good treatment responses, but longer disease durations of over 7 days and skin infections caused by Pseudomonas or other uncommon species were poor prognostic factors that should receive more attention.
