Hemorrhagic Acalculous Cholecystitis in Pyogenic Spondylodiscitis Patient / 대한췌담도학회지

Hemorrhagic cholecystitis (HC) is a rare form of cholecystitis that may be caused by the progression of either calculous or acalculous cholecystitis, which has been reported sporadically as case reports. Acalculous cholecystitis is often diagnosed late and can be fulminant. HC without gallstones also can have a poor prognosis and be linked to a high mortality rate. Therefore, early detection, hemodynamic monitoring, and prompt treatment are essential to treat bleeding in cholecystitis. We report a case of hemorrhagic acalculous cholecystitis discovered during the examination and point-of-care ultrasound in a patient with pyogenic spondylodiscitis. The patient was referred with a chief complaint of liver dysfunction without bleeding tendencies or risk factors. Ultrasound revealed focal gallbladder wall irregularity, intraluminal membranes, and non-shadowing non-layering intraluminal echoes. Extravascular contrast leakage was exhibited on the computed tomography scan. The patient underwent emergency percutaneous drainage and subsequent cholecystectomy before developing major complications.

Prevalence and Associated Factors of Depression and Anxiety Among Healthcare Workers During the Coronavirus Disease 2019 Pandemic:A Nationwide Study in Korea

Background@#A healthcare system’s collapse due to a pandemic, such as the coronavirus disease 2019 (COVID-19), can expose healthcare workers (HCWs) to various mental health problems. This study aimed to investigate the impact of the COVID-19 pandemic on the depression and anxiety of HCWs. @*Methods@#A nationwide questionnaire-based survey was conducted on HCWs who worked in healthcare facilities and public health centers in Korea in December 2020. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure depression and anxiety. To investigate factors associated with depression and anxiety, stepwise multiple logistic regression analysis was performed. @*Results@#A total of 1,425 participating HCWs were included. The mean depression score (PHQ-9) of HCWs before and after COVID-19 increased from 2.37 to 5.39, and the mean anxiety score (GAD-7) increased from 1.41 to 3.41. The proportion of HCWs with moderate to severe depression (PHQ-9 ≥ 10) increased from 3.8% before COVID-19 to 19.5% after COVID-19, whereas that of HCWs with moderate to severe anxiety (GAD-7 ≥ 10) increased from 2.0% to 10.1%. In our study, insomnia, chronic fatigue symptoms and physical symptoms after COVID-19, anxiety score (GAD-7) after COVID-19, living alone, and exhaustion were positively correlated with depression. Furthermore, post-traumatic stress symptoms, stress score (Global Assessment of Recent Stress), depression score (PHQ-9) after COVID-19, and exhaustion were positively correlated with anxiety. @*Conclusion@#In Korea, during the COVID-19 pandemic, HCWs commonly suffered from mental health problems, including depression and anxiety. Regularly checking the physical and mental health problems of HCWs during the COVID-19 pandemic is crucial, and social support and strategy are needed to reduce the heavy workload and psychological distress of HCWs.

Pneumonia Prevalence Upon Chest Radiography According to Vaccination Status Among Patients Under 50 Years of Age With Coronavirus Disease 2019

Background@#Coronavirus disease 2019 (COVID-19) vaccination is effective in preventing the disease transmission and progression. However, the relatively mild disease course of the omicron variant and the decrease in antibodies over time after vaccination raise questions about the effectiveness of vaccination, especially in young people. We compared the prevalence of pneumonia and chest X-ray severity score according to vaccination status among patients < 50 years old with COVID-19. @*Methods@#From January 17 to March 17, 2022, 579 patients with COVID-19, who were < 50 years old and had a known vaccination history in our institution, were all included in this study. All patients underwent initial chest radiography, and follow-up chest radiographs were obtained every two days until discharge. Pneumonia was scored from the radiographs using the Brixia scoring system. The scores of the six lung zones were added for a total score ranging from 0 to 18. Patients were divided into four groups according to 10-year age intervals. Differences between groups were analyzed using the χ2 or Fisher’s exact tests for categorical variables and the Kruskal–Wallis test or analysis of variance for continuous variables. @*Results@#Among patients aged 12–19 years, the prevalence of pneumonia did not differ depending on vaccination status (non-vaccinated vs. vaccinated, 1/47 [2.1%] vs. 1/18 [5.6%]; P = 0.577).Among patients in their 20s, the prevalence of pneumonia was significantly higher among nonvaccinated patients than among vaccinated patients (8/28, 28.6% vs. 7/138, 5.1%, P < 0.001), similar to patients in their 40s (32/52 [61.5%] vs. 18/138 [13.0%]; P < 0.001). The chest X-ray severity score was also significantly higher in non-vaccinated patients than that in vaccinated patients in their 20s to their 40s (P < 0.001), but not among patients aged 12–19 years (P = 0.678). @*Conclusion@#In patients aged 20–49 years, vaccinated patients had a significantly lower prevalence of pneumonia and chest X-ray severity score than non-vaccinated patients.

Assessment of the Suitability of the Fleischner Society Imaging Guidelines in Evaluating Chest Radiographs of COVID-19 Patients

Background@#The Fleischner Society established consensus guidelines for imaging in patients with coronavirus disease 2019 (COVID-19). We investigated the prevalence of pneumonia and the adverse outcomes by dividing groups according to the symptoms and risk factors of patients and assessed the suitability of the Fleischner society imaging guidelines in evaluating chest radiographs of COVID-19 patients. @*Methods@#From February 2020 to May 2020, 685 patients (204 males, mean 58 ± 17.9 years) who were diagnosed with COVID-19 and hospitalized were included. We divided patients into four groups according to the severity of symptoms and presence of risk factors (age > 65 years and presence of comorbidities). The patient groups were defined as follows: group 1 (asymptomatic patients), group 2 (patients with mild symptoms without risk factors), group 3 (patients with mild symptoms and risk factors), and group 4 (patients with moderate to severe symptoms). According to the Fleischner society, chest imaging is not indicated for groups 1–2 but is indicated for groups 3–4. We compared the prevalence and score of pneumonia on chest radiographs and compare the adverse outcomes (progress to severe pneumonia, intensive care unit admission, and death) between groups. @*Results@#Among the 685 COVID-19 patients, 138 (20.1%), 396 (57.8%), 102 (14.9%), and 49 (7.1%) patients corresponded to groups 1 to 4, respectively. Patients in groups 3–4 were significantly older and showed significantly higher prevalence rates of pneumonia (group 1–4: 37.7%, 51.3%, 71.6%, and 98%, respectively, P < 0.001) than those in groups 1-2. Adverse outcomes were also higher in groups 3–4 than in groups 1–2 (group 1–4: 8.0%, 3.5%, 6.9%, and 51%, respectively, P < 0.001). Patients with adverse outcomes in group 1 were initially asymptomatic but symptoms developed during follow-up. They were older (mean age, 80 years) and most of them had comorbidities (81.8%). Consistently asymptomatic patients had no adverse events. @*Conclusion@#The prevalence of pneumonia and adverse outcomes were different according to the symptoms and risk factors in COVID-19 patients. Therefore, as the Fleischner Society recommended, evaluation and monitoring of COVID-19 pneumonia using chest radiographs is necessary for old symptomatic patients with comorbidities.

Current Status of Q Fever and the Challenge of Outbreak Preparedness in Korea: One Health Approach to Zoonoses

Human Q fever, a zoonosis caused by Coxiella burnetii, presents with diverse clinical manifestations ranging from mild self-limited febrile illnesses to life-threatening complications such as endocarditis or vascular infection. Although acute Q fever is a benign illness with a low mortality rate, a large-scale outbreak of Q fever in the Netherlands led to concerns about the possibility of blood transfusion-related transmission or obstetric complications in pregnant women. Furthermore, a small minority (< 5%) of patients with asymptomatic or symptomatic infection progress to chronic Q fever. Chronic Q fever is fatal in 5–50% of patients if left untreated. In South Korea, Q fever in humans was designated as a notifiable infectious disease in 2006, and the number of Q fever cases has increased sharply since 2015. Nonetheless, it is still considered a neglected and under-recognized infectious disease. In this review, recent trends of human and animal Q fever in South Korea, and public health concerns regarding Q fever outbreaks are reviewed, and we consider how a One Health approach could be applied as a preventive measure to prepare for zoonotic Q fever outbreaks.

Effectiveness and Safety of COVID-19 Vaccination During Preconceptional and Preclinical Pregnancy Period: A National Population Study

Background@#We aimed to assess the risk of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and early abortive outcomes after the association between coronavirus disease 2019 (COVID-19) vaccination during the preconceptional period and preclinical pregnancy, which are likely to be inadvertent vaccination. @*Methods@#We used data from the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service cohort from December 2020 to December 2021. The vaccinated pregnant women were matched to unvaccinated pregnant controls at a 1:4 ratio.The risks of SARS-CoV-2 infection and intensive care unit (ICU) admission within 14 days of infection were analyzed to assess its effectiveness. For safety measures, the adjusted relative risks (aRRs) of early abortive outcomes for the first COVID-19 vaccination during the preconceptional and preclinical periods were calculated considering covariates. We compared the risk of early abortion between mRNA and viral vector vaccines. @*Results@#The overall COVID-19 vaccination rates during the preconceptional period and preclinical pregnancy were 3.1% (6,662/215,211) and 2.6% (5,702/215,211), respectively.The cumulative incidence of ICU admission within 14 days of SARS-CoV-2 infection was 6/100,000 in the unvaccinated group, whereas there were no ICU admissions in the vaccinated groups. The risks of early abortive outcomes were not significantly different between the preconceptional vaccination group and the unvaccinated group (aRR, 1.04; 95% confidence interval [CI],0.99–1.10) or between preclinical pregnancy vaccination and their matched controls (1.02; 95% CI, 0.96–1.08). mRNA and viral vector vaccines have shown similar risks for early abortive outcomes and miscarriages. @*Conclusion@#Our findings have provided compelling evidence regarding the effectiveness and safety of COVID-19 vaccination prior to and during early pregnancy. Further research is required to extend the safety and efficacy profiles of COVID-19 vaccines to pregnant women and their babies.

Seasonality of Coumarin Composition and Antioxidant Activities in Daphne jejudoensis

Daphne jejudoensis, an endemic plant found in Gotjawal area in Jeju Island, was reported as a new species in 2013 due to its distinct characteristics and distribution, which differentiate it from its related species, D. kiusiana. This study focuses on the comparative phytochemical analysis and antioxidant activities of D. jejudoensis leaves based on the collection period in order to identify the optimal harvest time. Daphnin and daphnetin were identified as the major components with the highest content observed in samples collected during spring, and the highest antioxidant activities were recorded during the same time period. This study represents the first investigation into the quantitative analysis of daphnin and daphnetin in the leaves of D. jejudoensis based on the collection period.

The prognostic value of comprehensive geriatric assessment on the management of older patients with small cell lung cancer

Background/Aims@#The prognostic value of a comprehensive geriatric assessment (CGA) for the management of older small cell lung cancer (SCLC) patients remains to be established. @*Methods@#A retrospective cohort enrolled 21 SCLC patients over 65 years from March 2018 to 2019 at the Yonsei Cancer Center. The CGA included the following instruments: frailty, body mass index, sarcopenia (circumference of arm and calf, Timed Up and Go test, grip strength), comorbidity, polypharmacy, activities of daily living (ADL), Instrumental ADL, nutrition, depression, and cognitive function. The correlations of oncological and geriatric variables with overall survival (OS) were determined. The log-rank test with Cox model and Kaplan-Meier method were used for the analysis. @*Results@#The median age was 75 years (range, 67 to 85). All patients had the Eastern Cooperative Oncology Group performance status 0–2. The median survival was 9.93 months (range, 1.53 to 36.30). Among CGA parameters, ADL and nutritional status had significant differences in OS in univariate analysis. In multivariate analysis, only nutritional status was independently associated with survival (hazard ratio, 0.17; 95% confidence interval, 0.05 to 0.57). Median OS for low nutritional status was 5.63 months and the normal nutrition group was 15.5 months (p = 0.004). @*Conclusions@#Pre-treatment nutritional status measured by CGA appears to be a predictor of OS in older SCLC patients. However, for further generalization of the implication of CGA in SCLC, a larger scale study with prospective design is strongly needed.

Preoperative Videourodynamic Study Is Helpful in Predicting Long-term Postoperative Voiding Function in Asymptomatic Patients With Closed Spinal Dysraphism / 대한배뇨장애요실금학회지

Purpose@#Controversy exists regarding the role preoperative urodynamic study for asymptomatic closed spinal dysraphism as it has failed to reveal the benefit in surgical decision and expectation of urological outcomes. We explore the relationship between preoperative videourodynamic study and postoperative urological outcomes after toilet training completed, focusing on their capability of spontaneous voiding. @*Methods@#We retrospectively reviewed the data of 181 patients who underwent preventive spinal cord untethering and followed at least till the completion of toilet training. Before untethering, patients underwent preoperative videourodynamic study. Postoperative voiding function was evaluated in 3 phases: (1) till postoperative 6 months, (2) till the completion of toilet training, and (3) 2 years after toilet training. Changing distribution of emptying pattern at each period was described. Also, relevance to preoperative urodynamic parameters on spontaneous voiding and urinary continence after toilet training was assessed. @*Results@#Spinal lipoma and low lying conus were found in 145 (80%) and 128 patients (70.7%), respectively. Spontaneous voiding was found in 125 (69.1%), 164 (90.6%), and 162 patients (89.5%) at postoperative 6 months, till the toilet training, and 2 years after toilet training, respectively. Videourodynamics helped to clarify the presence of vesicourethral synergy. This was correlated with spontaneous voiding at postoperative 6 months and better urinary continence after 2 years of toilet training. @*Conclusions@#Eventual spontaneous voiding was achieved till toilet training in 90% patients following preventive untethering. Those showing preoperative vesicourethral synergy was associated with faster achievement of spontaneous voiding and better urinary continence when they enter elementary school.

Short Communication: Links between Dental Hygiene Curriculum and Dental Hygiene Task Analysis / 치위생과학회지

Background@#The problem with current dental hygienist education is that it operates as an education system based on the national examination rather than on a practical basis; thus, graduates have difficulties in practice after obtaining their license. This study aimed to propose a job-oriented curriculum by analyzing the links between the task analysis of Korean dental hygienists and dental hygiene learning goals. @*Methods@#This study performed a relationship analysis based on a second job analysis study of dental hygienists conducted by the Korea Health Personnel Licensing Examination Institute and the learning goals of the Korean Dental Hygiene Faculty Association. @*Results@#Based on the links between the task and learning goals of the dental hygienist, they were classified into six types: 1) tasks listed in the license exam and learning goal, 2) tasks not listed in the license exam but listed in learning goals, 3) tasks not listed in learning goals, 4) learning goals not related to tasks, 5) learning goals listed in a few tasks, and 6) tasks related to several learning goals. The results showed that most of them correspond to the 5th classification, followed by the 3rd and 4th categories, which are mostly basic science learning goals. Tasks without learning goals are not included in the curriculum; thus, the curriculum needs to be supplemented. The overlapping learning goals of several subjects for one job skill must be reduced in job-oriented education. @*Conclusion@#We suggest that the dental hygiene curriculum be developed based on task analysis and reflected in the national dental hygienist exam. The clinical practice performance of dental hygienists will take further leap forward through task-oriented education.

Factors Related to Successful Tuberculosis Treatment in Vulnerable Groups / 대한내과학회지

Background/Aims@#Although the incidence and mortality of tuberculosis are decreasing in South Korea, the number of applications for financial assistance with the cost of tuberculosis treatment made by individuals from vulnerable groups was 3.8 times higher in 2019 compared to 2017 (Tuberculosis Relief Belt Project, 2019). @*Methods@#We analyzed the data of patients who received financial aid for tuberculosis treatment (in the period 2014-2018) from the Tuberculosis Relief Belt Project, which was designed to assist vulnerable groups. This study analyzed 137 subjects, and the independent variables included patient factors (age, gender, nationality, tuberculosis type, number of comorbidities, and place of residence) and treatment type (outpatient or inpatient). The dependent variable was the treatment outcome. @*Results@#The likelihood of treatment success was significantly lower for patients with one (odds ratio [OR] 0.202), two (OR 0.147), or three or more (OR 0.070) comorbidities compared to those with no comorbidities. This was also the case for patients living alone (OR 0.097), and for those classified as homeless (OR 0.053). Korean patients (OR 8.512) had a significantly higher probability of a successful treatment outcome than foreigners. @*Conclusions@#Appropriate community-based management of individuals with tuberculosis from vulnerable groups, including foreigners, people with comorbidities, people living alone, and people with an unstable residential situation or homeless status, is important.

Clinical and immunological signatures of severe COVID-19 in previously healthy patients with clonal hematopoiesis

Identifying additional risk factors for COVID-19 severity in numerous previously healthy patients without canonical clinical risk factors remains challenging. In this study, we investigate whether clonal hematopoiesis of indeterminate potential (CHIP), a common aging-related process that predisposes various inflammatory responses, may exert COVID-19 severity. We examine the clinical impact of CHIP in 143 laboratory-confirmed COVID-19 patients. Both stratified analyses and logistic regression including the interaction between canonical risk factors and CHIP show that CHIP is an independent risk factor for severe COVID-19, especially in previously healthy patients. Analyses of 60,310 single-cell immune transcriptome profiles identify distinct immunological signatures for CHIP (+) severe COVID-19 patients, particularly in classical monocytes, with a marked increase in pro-inflammatory cytokine responses and potent IFN-{gamma} mediated hyperinflammation signature. We further demonstrate that the enhanced expression of CHIP (+) specific IFN-{gamma} response genes is attributed to the CHIP mutation-dependent epigenetic reprogramming of poised or bivalent cis-regulatory elements. Our results highlight a unique immunopathogenic mechanism of CHIP in the progression of severe COVID-19, which could be extended to elucidate how CHIP contributes to a variety of human infectious diseases.

Significance of Evaluation for von Willebrand Disease in Premenopausal Women with Iron Deficiency Anemia and Menorrhagia / 임상소아혈액종양

Background@#In Korea, in the case of patients with significant bleeding symptoms due to unknown causes, there are very few studies that evaluate bleeding disorders, including von Willebrand disease (VWD ). VWD should be considered as an important causative factor in patients with iron deficiency anemia (IDA) and unexplained menorrhagia. This study aimed to understand the clinical characteristics of VWD and the significance of evaluation for VWD in premenopausal women in Korea with menorrhagia and ID A. @*Methods@#Premenopausal women who were diagnosed with IDA and menorrhagia from January 2009 to March 2020 were included. IDA was diagnosed by either low ferritin or transferrin saturation with microcytic anemia. Menorrhagia was evaluated based on the medical records obtained from a gynecologist. VWD diagnosis was defined as von Willebrand factor antigen ＜50% and von Willebrand factor ristocetin cofactor activity ＜50%, which were low according to the Hospital for Sick Children criteria. @*Results@#Out of a total of 120 patients, only 12 were tested for VWD, all of whom were pediatric patients. Four of the 12 pediatric patients tested were diagnosed with VWD and 4 of the 120 (3.3%) patients with IDA and menorrhagia were diagnosed with VWD. Three out of the 4 patients was diagnosed with VWD by repeat screening test. Although all parameters are not statistically significant, VWD patients tended to have ID A at a younger age (13.25 vs. 15.00 years) and were more likely to have recurrent IDA than patients without VWD. @*Conclusion@#Clinical doctors should consider VWD if patients have menorrhagia with ID A. If VWD is suspected, repeated VWD screening tests are necessary to increase the diagnosis rate. Accurate diagnosis of VWD in patients with significant bleeding may facilitate decisions for appropriate treatment.

Daytime Glycemic Variability and Frailty in Older Patients with Diabetes: a Pilot Study Using Continuous Glucose Monitoring

We investigated the relationship between glucose variability and frailty. Forty-eight type 2 diabetic patients aged ≥ 65 years were enrolled. The FRAIL scale was used for frailty assessment, and participants were classified into ‘healthy & pre-frail’ (n = 24) and ‘frail’ (n = 24) groups. A continuous glucose monitoring (CGM) system was used for a mean of 6.9 days and standardized CGM metrics were analyzed: mean glucose, glucose management indicator (GMI), coefficient of variation, and time in range, time above range (TAR), and time below range. The demographics did not differ between groups. However, among the CGM metrics, mean glucose, GMI, and TAR in the postprandial periods were higher in the frail group (all P < 0.05). After multivariate adjustments, the post-lunch TAR (OR = 1.12, P = 0.019) affected the prevalence of frailty. Higher glucose variability with marked daytime postprandial hyperglycemia is significantly associated with frailty in older patients with diabetes.

The Experiences of Health Care Workers during the COVID-19 Pandemic in Korea: a Qualitative Study

Background@#During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have faced multiple physical and psychological challenges while carrying out their duties. In this study, we examined the experiences of specific groups of HCWs during the pandemic. @*Methods@#From 18 November to 30 December 2020, we conducted a qualitative study using semi-structured, face-to-face interviews with four groups of 14 HCWs in three cities (Seoul, Daegu, and Gwangju) in South Korea. The HCWs who participated in the focus groups included physicians, nurses, medical practitioners, and cleaning staff who directly or indirectly cared for patients during the COVID-19 epidemic. Interviews were transcribed verbatim and analyzed using the consensual qualitative research approach. @*Results@#Our qualitative data analysis revealed four main domains: work-related struggles, personal life-related struggles, psychological stress, and health-related struggles. Health care providers were challenged by working in critical situations and were overwhelmed by heavy workloads, fear of infection, lifestyle changes, and psychological and physical struggles. @*Conclusion@#Our findings could serve as a foundation for establishing health care systems and policies that help HCWs cope with occupational stress, thus increasing their ability to adapt to the ongoing COVID-19 pandemic.

Clinically Significant Monocyte Biomarker for Differential Diagnosis of COVID-19 Pneumonia in the Emergency Department / 계명의대학술지

Objectives@#To determine basic patient characteristics and biomarkers to help in the early diagnosis of Coronavirus disease 2019 (COVID-19) pneumonia in patients with pneumonia who visited the emergency department (ED). @*Methods@#This retrospective study evaluated patients diagnosed with community-acquired pneumonia (CAP) or COVID-19 pneumonia in ED at four tertiary medical centers between February 1 and March 31, 2020. Parameters related to the differential diagnosis between CAP and COVID-19 were investigated. Clinical characteristics and laboratory results of biomarkers were analyzed. @*Results@#In total, 81 patients presented to the ED with COVID-19 pneumonia. Multivariate logistic regression analysis showed that monocyte count [odds ratio (OR): 0.996; 95% confidence interval (CI): 0.994–0.999] and pneumonia severity index (PSI) [OR: 1.025; 95% CI: 1.002–1.049] were associated with diagnosis of COVID-19 pneumonia. The area under the curve comprising the combination of monocyte and PSI was 0.789. @*Conclusion@#Differential diagnosis of COVID-19 pneumonia from pneumonia patients who visited the emergency room can be made by monocyte count and PSI score.

Academic Stress and Its Influencing Factors among Medical and Non‐Medical Students / 의학교육논단

This study examined the relationships among personality traits, coping efficacy, and academic stress in medical and non-medical students in South Korea, and investigated the mediating effect of coping efficacy in the relationship between personality traits and academic stress. The study group comprised 210 medical students and 175 non-medical students. They were asked to rate their personality traits, coping efficacy, and academic stress. The data were analyzed using IBM SPSS ver. 26.0 (IBM Corp., Armonk, NY, USA) and AMOS ver. 26.0 (IBM Corp.). Medical students scored higher for examination stress and lower for extroversion than non-medical students. In both groups, extroversion and conscientiousness positively affected coping efficacy, while neuroticism influenced it negatively. Neuroticism directly influenced all types of academic stress in both groups, while extroversion and conscientiousness only had direct effects on examination stress among medical students. Coping efficacy mediated the associations between personality traits and academic stress, except for the relationship between neuroticism and grade stress among medical students. The study indicates that coping efficacy had a significant effect on relieving academic stress among students with higher scores for extroversion and conscientiousness. Efforts should be made to decrease neuroticism to lower academic stress, as the relationship between neuroticism and academic stress is not directly influenced by coping efficacy. The implications of these results are discussed regarding a consultation system for students, especially those in medical school.

Ipragliflozin, an SGLT2 Inhibitor, Ameliorates High-Fat Diet-Induced Metabolic Changes by Upregulating Energy Expenditure through Activation of the AMPK/ SIRT1 Pathway

Background@#Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new class of antidiabetic drugs that exhibit multiple extraglycemic effects. However, there are conflicting results regarding the effects of SGLT2 inhibition on energy expenditure and thermogenesis. Therefore, we investigated the effect of ipragliflozin (a selective SGLT2 inhibitor) on energy metabolism. @*Methods@#Six-week-old male 129S6/Sv mice with a high propensity for adipose tissue browning were randomly assigned to three groups: normal chow control, 60% high-fat diet (HFD)-fed control, and 60% HFD-fed ipragliflozin-treated groups. The administration of diet and medication was continued for 16 weeks. @*Results@#The HFD-fed mice became obese and developed hepatic steatosis and adipose tissue hypertrophy, but their random glucose levels were within the normal ranges; these features are similar to the metabolic features of a prediabetic condition. Ipragliflozin treatment markedly attenuated HFD-induced hepatic steatosis and reduced the size of hypertrophied adipocytes to that of smaller adipocytes. In the ipragliflozin treatment group, uncoupling protein 1 (Ucp1) and other thermogenesis-related genes were significantly upregulated in the visceral and subcutaneous adipose tissue, and fatty acid oxidation was increased in the brown adipose tissue. These effects were associated with a significant reduction in the insulin-to-glucagon ratio and the activation of the AMP-activated protein kinase (AMPK)/sirtuin 1 (SIRT1) pathway in the liver and adipose tissue. @*Conclusion@#SGLT2 inhibition by ipragliflozin showed beneficial metabolic effects in 129S6/Sv mice with HFD-induced obesity that mimics prediabetic conditions. Our data suggest that SGLT2 inhibitors, through their upregulation of energy expenditure, may have therapeutic potential in prediabetic obesity.

Development of 3D Printed Snack-dish for the Elderly with Dementia / 대한지역사회영양학회지

Objectives@#This study was conducted to create a 3D printable snack dish model for the elderly with low food or fluid intake along with barriers towards eating. @*Methods@#The decision was made by the hybrid-brainstorming method for creating the 3D model. Experts were assigned based on their professional areas such as clinical nutrition, food hygiene and chemical safety for the creation process. After serial feedback processes, the grape shape was suggested as the final model. After various concept sketching and making clay models, 3D-printing technology was applied to produce a prototype. @*Results@#3D design modeling process was conducted by SolidWorks program. After considering Dietary reference intakes for Koreans (KDRIs) and other survey data, appropriate supplementary water serving volume was decided as 285 mL which meets 30% of Adequate intake. To consider printing output conditions, this model has six grapes in one bunch with a safety lid. The FDM printer and PLA filaments were used for food hygiene and safety. To stimulate cognitive functions and interests of eating, numbers one to six was engraved on the lid of the final 3D model. @*Conclusions@#The newly-developed 3D model was designed to increase intakes of nutrients and water in the elderly with dementia during snack time. Since dementia patients often forget to eat, engraving numbers on the grapes was conducted to stimulate cognitive function related to the swallowing and chewing process. We suggest that investigations on the types of foods or fluids are needed in the developed 3D model snack dish for future studies.

Significance of Evaluation for von Willebrand Disease in Premenopausal Women with Iron Deficiency Anemia and Menorrhagia / 임상소아혈액종양

Background@#In Korea, in the case of patients with significant bleeding symptoms due to unknown causes, there are very few studies that evaluate bleeding disorders, including von Willebrand disease (VWD ). VWD should be considered as an important causative factor in patients with iron deficiency anemia (IDA) and unexplained menorrhagia. This study aimed to understand the clinical characteristics of VWD and the significance of evaluation for VWD in premenopausal women in Korea with menorrhagia and ID A. @*Methods@#Premenopausal women who were diagnosed with IDA and menorrhagia from January 2009 to March 2020 were included. IDA was diagnosed by either low ferritin or transferrin saturation with microcytic anemia. Menorrhagia was evaluated based on the medical records obtained from a gynecologist. VWD diagnosis was defined as von Willebrand factor antigen ＜50% and von Willebrand factor ristocetin cofactor activity ＜50%, which were low according to the Hospital for Sick Children criteria. @*Results@#Out of a total of 120 patients, only 12 were tested for VWD, all of whom were pediatric patients. Four of the 12 pediatric patients tested were diagnosed with VWD and 4 of the 120 (3.3%) patients with IDA and menorrhagia were diagnosed with VWD. Three out of the 4 patients was diagnosed with VWD by repeat screening test. Although all parameters are not statistically significant, VWD patients tended to have ID A at a younger age (13.25 vs. 15.00 years) and were more likely to have recurrent IDA than patients without VWD. @*Conclusion@#Clinical doctors should consider VWD if patients have menorrhagia with ID A. If VWD is suspected, repeated VWD screening tests are necessary to increase the diagnosis rate. Accurate diagnosis of VWD in patients with significant bleeding may facilitate decisions for appropriate treatment.