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Purpose@#The Korean Society of Coloproctology has been conducting Colorectal Cancer Awareness Campaign, also known as the Gold Ribbon Campaign, every September since 2007. The 2022 campaign was held through a metaverse platform targeting the younger age group under the slogan of raising awareness of early-onset colorectal cancer (CRC). This study aimed to analyze the impact of the 2022 campaign on a metaverse platform. @*Methods@#Anonymized survey data were collected from participants in the metaverse campaign from September 1 to 15, 2022. The satisfaction score of the participants was evaluated by sex, age group, and previous campaign participation status. @*Results@#During the campaign, 2,770 people visited the metaverse. Among them, 455 people participated in the survey (response rate, 16.4%). Approximately 95% of the participants reported being satisfied with the information provided by the campaign, understood the necessity of undergoing screening for and prevention of early-onset CRC, and were familiar with the structure of the metaverse. The satisfaction score for campaign information tended to decrease as the participants’ age increased. When the participants’ overall level of satisfaction with the metaverse platform was assessed, teenagers scored particularly lower than the other age groups. The satisfaction scores for CRC information provided in the metaverse, as well as the scores for recognizing the seriousness and necessity of screening for early-onset CRC, indicated a high positive tendency (P<0.001). @*Conclusion@#Most of the 2022 Gold Ribbon Campaign participants were satisfied with the metaverse platform. Medical society should pay attention to increasing participation in and satisfaction with future public campaigns.
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During the coronavirus disease 2019 (COVID-19) pandemic, conclusively evaluating possible associations between COVID-19 vaccines and potential adverse events was of critical importance. The National Academy of Medicine of Korea established the COVID-19 Vaccine Safety Research Center (CoVaSC) with support from the Korea Disease Control and Prevention Agency to investigate the scientific relationship between COVID-19 vaccines and suspected adverse events. Although determining whether the COVID-19 vaccine was responsible for any suspected adverse event necessitated a systematic approach, traditional causal inference theories, such as Hill's criteria, encountered certain limitations and criticisms. To facilitate a systematic and evidence-based evaluation, the United States Institute of Medicine, at the request of the Centers for Disease Control and Prevention, offered a detailed causality assessment framework in 2012, which was updated in the recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM) in 2024.This framework, based on a weight-of-evidence approach, allows the independent evaluation of both epidemiological and mechanistic evidence, culminating in a comprehensive conclusion about causality. Epidemiological evidence derived from population studies is categorized into four levels—high, moderate, limited, or insufficient—while mechanistic evidence, primarily from biological and clinical studies in animals and individuals, is classified as strong, intermediate, weak, or lacking. The committee then synthesizes these two types of evidence to draw a conclusion about the causal relationship, which can be described as “convincingly supports” (“evidence established” in the 2024 NASEM report), “favors acceptance,” “favors rejection,” or “inadequate to accept or reject.” The CoVaSC has established an independent committee to conduct causality assessments using the weightof-evidence framework, specifically for evaluating the causality of adverse events associated with COVID-19 vaccines. The aim of this study is to provide an overview of the weight-ofevidence framework and to detail the considerations involved in its practical application in the CoVaSC.
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The COVID-19 Vaccine Safety Research Committee (CoVaSC) was established in November 2021 to address the growing need for independent, in-depth scientific evidence on adverse events (AEs) following coronavirus disease 2019 (COVID-19) vaccination. This initiative was requested by the Korea Disease Control and Prevention Agency and led by the National Academy of Medicine of Korea. In September 2022, the COVID-19 Vaccine Safety Research Center was established, strengthening CoVaSC’s initiatives. The center has conducted various studies on the safety of COVID-19 vaccines. During CoVaSC’s second research year, from September 29, 2022 to July 19, 2023, the center was restructured into 4 departments: Epidemiological Research, Clinical Research, Communication & Education, and International Cooperation & Policy Research. Its main activities include (1) managing CoVaSC and the COVID-19 Vaccine Safety Research Center, (2) surveying domestic and international trends in AE causality investigation, (3) assessing AEs following COVID-19 vaccination, (4) fostering international collaboration and policy research, and (5) organizing regular fora and training sessions for the public and clinicians. Causality assessments have been conducted for 27 diseases, and independent research has been conducted after organizing ad hoc committees comprising both epidemiologists and clinical experts on each AE of interest. The research process included protocol development, data analysis, interpretation of results, and causality assessment. These research outcomes have been shared transparently with the public and healthcare experts through various fora. The COVID-19 Vaccine Safety Research Center plans to continue strengthening and expanding its research activities to provide reliable, high-quality safety information to the public.
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To improve the predictability of concentrations of atmospheric particulate matter, a data assimilation (DA) system using ensemble square root filter (EnSRF) has been developed for the Community Multiscale Air Quality (CMAQ) model. The EnSRF DA method is a deterministic variant of the ensemble Kalman filter (EnKF) method, which means that unlike the EnKF method, it does not add random noise to the observations. To compare the performances of the EnSRF with those of other DA methods, such as EnKF and 3DVAR (three-dimensional variational), these three methods were applied to the same CMAQ model simulations with identical experimental settings. This is the first attempt in the field of chemical DA to compare the EnKF and EnSRF methods. An identical set of surface fine particulate matter (PM2.5) were assimilated every 6 h by all the DA methods over a CMAQ domain of East Asia, during the period from 01 May to 11 June 2016. In parallel with 'reanalysis experiments', we also carried out '48 h prediction experiments' using the optimized initial conditions produced by the three DA methods. Detailed analyses among the three DA methods were then carried out by comparing both the reanalysis and the prediction outputs with the observed surface PM2.5 over four regions (i.e., South Korea, the Beijing-Tianjin-Hebei (BTH) region, Shandong province, and Liaoning province). The comparison results revealed that the EnSRF produced the best reanalysis and prediction fields in terms of several statistical metrics. For example, when the 3DVAR, EnKF, and EnSRF methods were used, averaged normalized mean biases (NMBs) decreased by (57.6, 85.6, and 91.8) % in reanalyses and (39.7, 87.6, and 91.5) % in first-day predictions, compared to the CMAQ control experiment (i.e., without DA) over South Korea, respectively. Also, over the three Chinese regions, the EnSRF method outperformed the EnKF and 3DVAR methods.
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Poluição do Ar , Modelos Teóricos , Poluição do Ar/análise , Material Particulado/análise , República da Coreia , Ásia OrientalRESUMO
Purpose@#To investigate whether postoperative filtering bleb size affects the surgical outcome after trabeculectomy. @*Methods@#In this study, we retrospectively reviewed 145 medically uncontrolled glaucoma patients with intraocular pressure (IOP) values >21 mmHg before surgery and data from ≥2 years of follow-up. Postoperative IOP, filtering bleb size including extent and height, and other clinical factors were measured after trabeculectomy. We divided bleb extent into quadrants and bleb height by 0.5 intervals of corneal thickness. The main outcome measure was surgical success. We confirmed complete success when the IOP was ≤21 mmHg and decreased by >20% from baseline without medication or additional procedures. Qualified success used the same criteria but allowed for medication or additional procedures. Cases with reoperation or two consecutive IOP measurements <6 mmHg were considered failures. @*Results@#A total of 145 eyes of 145 patients was included. The average observation period was 30.8 ± 10.9 months. During multivariate Cox regression analysis, a larger extent of filtering bleb revealed significantly low hazard ratios in both complete and surgical success (0.509 and 0.494, respectively); however, there was no significant relationship between bleb height and surgical outcome. @*Conclusions@#The extent of the filtering bleb was associated with surgical outcomes of trabeculectomy in glaucoma patients.
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With the introduction of coronavirus disease 2019 (COVID-19) vaccines, the Korea Disease Control and Prevention Agency (KDCA) commissioned the National Academy of Medicine of Korea to gather experts to independently assess post-vaccination adverse events. Accordingly, the COVID-19 Vaccine Safety Research Committee (CoVaSC) was launched in November 2021 to perform safety studies and establish evidence for policy guidance. The CoVaSC established 3 committees for epidemiology, clinical research, and communication. The CoVaSC mainly utilizes pseudonymized data linking KDCA’s COVID-19 vaccination data and the National Health Insurance Service’s claims data. The CoVaSC’s 5-step research process involves defining the target diseases and organizing ad-hoc committees, developing research protocols, performing analyses, assessing causal relationships, and announcing research findings and utilizing them to guide compensation policies. As of 2022, the CoVaSC completed this research process for 15 adverse events. The CoVaSC launched the COVID-19 Vaccine Safety Research Center in September 2022 and has been reorganized into 4 divisions to promote research including international collaborative studies, long-/short-term follow-up studies, and education programs. Through these enhancements, the CoVaSC will continue to swiftly provide scientific evidence for COVID-19 vaccine research and compensation and may serve as a model for preparing for future epidemics of new diseases.
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Purpose@#The accuracy and agreement of intraocular pressure (IOP) measurements using a noncontact self-measuring tonometer, TONO-i, compared with the Goldmann applanation tonometer (GAT). @*Methods@#A total of 35 healthy participants and 42 primary open angle or normal tension glaucoma patients were enrolled in this study. TONO-i and GAT measurements were obtained and the mean difference in IOPs was analyzed using a paired t-test. IOP agreement was calculated using the two-way random effects model. Bland-Altman analysis and simple linear regression were used to estimate the disagreement between IOP measurements. @*Results@#The mean IOPs measured using the TONO-i and GAT were 15.9 ± 3.3 mmHg and 16.4 ± 5.1 mmHg, respectively. In glaucoma patients, the mean values measured using the TONO-i (16.7 ± 4.1 mmHg) were lower than those measured using the GAT (17.9 ± 6.1 mmHg; p < 0.001). However, there was no significant difference among the healthy participants (p = 0.273). The intraclass coefficients (95% confidence interval) for all participants, normal participants, and glaucoma patients were 0.847 (0.702-0.920), 0.882 (0.804-0.941), and 0.828 (0.742-0.887), respectively, indicating good agreement between the IOP measurements. The mean difference and limits of agreement were not statistically significant. As IOP increased, the absolute difference between the GAT and TONO-i measurements also increased. @*Conclusions@#The TONO-i, a novel tonometer, may be used reliably for IOP self-measurement and detecting IOP elevations. However, caution must be exercised because of the possibility of underestimating high IOPs.
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Purpose@#Globally, chronic kidney disease (CKD) is common and has been associated with an increased risk of colorectal cancer (CRC). There is a dearth of literature on the real-world morbidity and mortality associated with CKD comorbid with CRC. This study was performed to evaluate real-world survival outcomes of colorectal malignancy in Korean CKD patients. @*Methods@#The National Health Insurance Service of Korea provided data on patients who underwent surgical resection among patients diagnosed with CRC from 2002 to 2019. @*Results@#A total of 219,550 patients were included: 6,181 patients with underlying CKD and 213,369 patients without it.Each morbidity was significantly higher in the CKD-CRC group, and the postoperative mortality rates for the 30-day (3.11% vs. 1.78%, P < 0.001), 60-day (5.95% vs. 3.83%, P < 0.001), and 90-day mortality rate (8.12% vs. 5.32%, P < 0.001) were significantly higher in the CKD group. The median survival time (MST, year) was significantly lower in the CKD-CRC group (5.63; interquartile range [IQR], 5.26–5.91) than in the non-CKD-CRC group (8.71; IQR, 8.37–8.93). MST was significantly lower among CKD patients who received chemotherapy after adjustment by multivariate analysis (adjusted hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.37–1.49; P < 0.001]). Subgroup analysis showed that in the CKD-CRC group, MST was lower in patients who received dialysis than in those who did not, even after multivariate analysis (adjusted HR, 2.38;95% CI, 2.20–2.58; P < 0.001). @*Conclusion@#Prevention of CKD-to-end-stage renal disease progression should be adopted as a strategy to increase postoperative survival, along with active surveillance and cancer treatment.
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Purpose@#To report an iris metastasis associated with non-small-cell lung cancer (NLC) confirmed via repeat aqueous humor cytology.Case summary: A 53-year-old female presented to our ophthalmology outpatient department with complaints of vision impairment and pain in the left eye 1 month in duration. In ophthalmologic examinations, the best-corrected visual acuities were 20/20 oculus dexter (OD) and 20/32 oculus sinister (OS). The intraocular pressures measured using standard Goldmann applanation tonometery were 12 mmHg OD and 42 mmHg OS. Slit-lamp examination revealed multiple iris nodules in the left eye. Thirteen months prior, the patient had been diagnosed with NLC and was on chemotherapy. Despite the maximal tolerated medical therapy, the intraocular pressure was not controlled. As an iris metastasis was suspected, anterior chamber paracentesis was performed for aqueous humor sampling. Cytological analysis did not reveal malignant cells. One week later, aqueous humor sampling was repeated. Malignant cells were histopathologically confirmed. Given the ocular metastasis, the oncologists changed the chemotherapy regimen. @*Conclusions@#When an NLC patient exhibits iris nodules, repeat aqueous humor cytology can confirm an iris metastasis.
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Fractures of the zygoma are rarely encountered in pediatric patients. This report presents a case of a 3-year-old child who presented with a vertically split fracture of the marginal tubercle of the zygoma. The marginal tubercle, a bony portion present on the posterior border of the frontal process, assists in attaching the temporalis fascia. This patient was treated surgically with bony fixation using tissue glue. To the best of our knowledge, no cases of fracture of the marginal tubercle of the zygoma have been reported in the literature. Fractures of the marginal tubercle of the zygoma in pediatric patients may be overlooked because of their anatomic location and the musculoskeletal characteristics of these patients. Here, we discuss the clinical features of marginal tubercle fractures of the zygoma.
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Fractures of the zygoma are rarely encountered in pediatric patients. This report presents a case of a 3-year-old child who presented with a vertically split fracture of the marginal tubercle of the zygoma. The marginal tubercle, a bony portion present on the posterior border of the frontal process, assists in attaching the temporalis fascia. This patient was treated surgically with bony fixation using tissue glue. To the best of our knowledge, no cases of fracture of the marginal tubercle of the zygoma have been reported in the literature. Fractures of the marginal tubercle of the zygoma in pediatric patients may be overlooked because of their anatomic location and the musculoskeletal characteristics of these patients. Here, we discuss the clinical features of marginal tubercle fractures of the zygoma.
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Purpose@#Cryptoglandular fistula is one of the common anal diseases requiring surgical treatment. Various surgical techniques have been introduced; however, there is no known standard technique. Coring-out fistulectomy is a surgical technique that accurately resects only the fistula tract. However, only a few cases of this procedure have been reported.We aimed to analyze the surgical outcomes of coring-out fistulectomy for cryptoglandular anal fistulas. @*Methods@#We retrospectively reviewed the medical records of patients who underwent coring-out fistulectomy for a cryptoglandular fistula between 1999 and 2019. Primary outcomes were the treatment success rate (recurrence and healing rates) and incidence of fecal incontinence. @*Results@#A total of 184 patients were included in our study. The average age of the patients was 44 years (range, 16–75 years), and 88.0% were male. Twenty-four (13.0%), 13 (7.1%), and 68 patients (37.0%) underwent operation for recurrent fistula, multiple tracts, and complex type fistula, respectively. The healing rate was 92.4%, and recurrence occurred in 15 of 170 healed patients (8.8%). Thus, the treatment success rate was 84.2%. There was no fecal incontinence except in 1 patient who had preoperative fecal incontinence because of cauda equine syndrome. In multivariable analysis of the factors affecting the treatment success rate, the complex fistula (odds ratio [OR], 14.2; 95% confidence interval [CI], 4.7– 43.0; P < 0.001) and undetected internal opening during the operation (OR, 4.0; 95% CI, 1.4–11.6; P = 0.012) were significant factors. @*Conclusion@#Coring-out fistulectomy is a simple and feasible technique for sphincter-preserving anal fistula surgery.
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Background@#There is no national survey on medical school faculty members’ burnout in Korea. This study aimed to investigate burnout levels and explore possible factors related to burnout among faculty members of Korean medical schools. @*Methods@#An anonymous online questionnaire was distributed to 40 Korean medical schools from October 2020 to December 2020. Burnout was measured by a modified and revalidated version of the Maslach Burnout Inventory-Human Service Survey. @*Results@#A total of 996 faculty members participated in the survey. Of them, 855 answered the burnout questions, and 829 completed all the questions in the questionnaire. A significant number of faculty members showed a high level of burnout in each sub-dimension: 34% in emotional exhaustion, 66.3% in depersonalization, and 92.4% in reduced personal accomplishment. A total of 31.5% of faculty members revealed a high level of burnout in two sub-dimensions, while 30.5% revealed a high level of burnout in all three sub-dimensions.Woman faculty members or those younger than 40 reported significantly higher emotional exhaustion and depersonalization. Long working hours (≥ 80 hours/week) showed the highest reduced personal accomplishment scores (F = 4.023, P = 0.018). The most significant stressor or burnout source was “excessive regulation by the government or university.” The research was the most exasperating task, but the education was the least stressful. @*Conclusion@#This first nationwide study alerts that a significant number of faculty members in Korean medical schools seem to suffer from a high level of burnout. Further studies are necessary for identifying the burnout rate, related factors, and strategies to overcome physician burnout.
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The purpose of this study is to clarify the background of the controversial attempt to establish a new public medical school linked to compulsory service as a means of strengthening public healthcare in Korea, and to raise anticipated problems with possible solutions. In Korea, healthcare is predominantly provided by the private sector focused on medical care, rather than public healthcare, even under the national health insurance system. The government has been mainly in charge of public health and unmet medical services from a residual perspective, but health inequalities still exist. To resolve this issue, the government created the concept of public health and medical service (PHMS) from a universal perspective and tried to strengthen the infrastructure of public healthcare and to foster core PHMS doctors by establishing a new public medical school linked to compulsory service in medically vulnerable areas. This study investigated the reality and concept of the new public medical school planned by the government, and identified problems such as the possibility of obtaining accreditation and evaluation before its establishment, the side effects of dividing doctors’ roles, the waste of huge amounts of resources, and insensitive policies. In conclusion, in order to resolve health inequalities in Korea, we need to train doctors through medical school education that strengthens the social responsibility of doctors along with strengthening public healthcare infrastructure, and to provide a better environment for doctors working in medically vulnerable areas through sophisticated policies.
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Weather is affected by a complex interplay of factors, including topography, location, and time. For the prediction of temperature in Korea, it is necessary to use data from multiple regions. To this end, we investigate the use of deep neural-network-based temperature prediction model time-series weather data obtained from an automatic weather station and image data from a regional data assimilation and prediction system (RDAPS). To accommodate such different types of data into a single model, a bidirectional long short-term memory (BLSTM) model and a convolutional neural network (CNN) model are chosen to represent the features from the time-series observed data and the RDAPS image data. The two types of features are combined to produce temperature predictions for up to 14 days in the future. The performance of the proposed temperature prediction model is evaluated by objective measures, including the root mean squared error and mean bias error. The experiments demonstrated that the proposed model combining both the observed and RDAPS image data is better in all performance measures for all prediction periods compared with the BLSTM-based model using observed data and the CNN-BLSTM-based model using RDAPS image data alone.
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Purpose@#This study explored how the Korean Medical Colleges responded to the coronavirus disease 2019 (COVID-19) pandemic and the medical deans’ perspectives on what and how these adaptions influence the present and the future of medical education. @*Methods@#An email survey combining short and open-ended questions was distributed to all 40 Korean school deans in May 2020. Thirty-seven deans out of 40 medical schools in Korea (92.5%) participated. @*Results@#Most lectures moved online but students’ assessments were delayed and later held onsite. Clinical rotations continued except for an average of 3-week suspension during the first COVID-19 wave. The deans’ remarks on the positive influences far outweighed the negative impact of COVID-19 on medical education. Although technological adaptations caused initial hardship, the experience gained through the use of various online learning systems led to attitudinal changes on the importance of adopting new technology and a tailored and student centric curriculum in medical education. @*Conclusion@#The deans’ perspective changes has shown the possibility of the deans’ generation aligning more closely with the current Generation Z medical students. They projected further innovations in teaching and learning methods, especially applying flipped learning and highlighted the need to invest in faculty development so medical educators can be equipped and competent in diverse ICT (information and communications technology) learning platforms. Also, the need for advance preparations in medical education for future similar public health crises were stressed. Unprecedented changes brought by COVID-19 positively impacted Korean medical education in parts and the Korean deans envisioned further innovations using the experiences gained during this crisis.
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This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.
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Purpose@#This study explored how the Korean Medical Colleges responded to the coronavirus disease 2019 (COVID-19) pandemic and the medical deans’ perspectives on what and how these adaptions influence the present and the future of medical education. @*Methods@#An email survey combining short and open-ended questions was distributed to all 40 Korean school deans in May 2020. Thirty-seven deans out of 40 medical schools in Korea (92.5%) participated. @*Results@#Most lectures moved online but students’ assessments were delayed and later held onsite. Clinical rotations continued except for an average of 3-week suspension during the first COVID-19 wave. The deans’ remarks on the positive influences far outweighed the negative impact of COVID-19 on medical education. Although technological adaptations caused initial hardship, the experience gained through the use of various online learning systems led to attitudinal changes on the importance of adopting new technology and a tailored and student centric curriculum in medical education. @*Conclusion@#The deans’ perspective changes has shown the possibility of the deans’ generation aligning more closely with the current Generation Z medical students. They projected further innovations in teaching and learning methods, especially applying flipped learning and highlighted the need to invest in faculty development so medical educators can be equipped and competent in diverse ICT (information and communications technology) learning platforms. Also, the need for advance preparations in medical education for future similar public health crises were stressed. Unprecedented changes brought by COVID-19 positively impacted Korean medical education in parts and the Korean deans envisioned further innovations using the experiences gained during this crisis.
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This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.
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Morel-Lavallée lesions (MLL) create pre-fascial space by shearing the subcutaneous tissues away from the underlying fascia, in a patient with trauma. Necrosis of the overlying skin can develop over a wide area of the lesion. The lesion might be contaminated by the surgical site due to careless intrusion when treating the combined arteriopathy. A 70-year-old woman presented with avulsion of the skin over the right foot and bilateral leg pain following a car accident. Computed tomography showed bilateral popliteal artery occlusion with large hematoma on both legs. Percutaneous angioplasty was performed with successful restoration of the flow. However, the skin color changes over time. Necrosis of the skin occurred over a wide area of the right leg. Extensive debridement was performed, and the defect was covered with a skin graft. MLLs can occur in patients with multiple traumas, multiple vascular injuries, and complex skeletal injury. Vascular surgeons treating multiple traumas should be aware of the diagnostic and management options for MLL. It should be diagnosed early because it can be difficult to manage once the overlying skin develops necrosis.