Background and Objectives: Despite remarkable reduction in cardiovascular disease (CVD) mortality, the burden has remained the leading cause of death. Since little research has focused on regional disparity in CVD mortality, this study aims to investigate its spatiotemporal trends in Korea from 1983 to 2019. Methods: Using the causes of death statistics in Korea, we analyzed the geographic variation in deaths from CVDs from 1983 to 2019. The sex and age-standardized mortality rate was calculated according to the 17 administrative regions. The analyses include all diseases of the circulatory system (International Classification of Diseases-10 codes, I00–I99), along with the following 6 subcategories which were not mutually exclusive: total heart disease (I00–I13 and I20–I51), hypertensive heart disease (I10–I13), ischemic heart disease (I20–I25), myocardial infarction (I21–I23), heart failure (I50), and cerebrovascular disease (I60–I69). Results: Overall, heart failure death rate increased across all regions, and other CVD death rates showed a decreasing trend. Regional disparity in mortality was substantial in the early 1980s but converged over time. In all types of cardiovascular mortality, Busan, Ulsan and Gyeongnam remained the highest, although they showed a downward trend like other regions. Jeju continued to have a relatively low CVD mortality rate. Conclusions The regional disparity substantially decreased compared to the 1980s. However, the relatively high burden of CVD mortality in the southeastern region has not been fully resolved.

Purpose: The purpose of the this study was to examine the dietary knowledge and educational needs of stroke patients and analyze the related factors that are associated with dietary knowledge and educational needs. Methods: Our study analyzed data from 146 stroke patients. The survey was conducted by individual interviews using questionnaires and data collected from participants’ medical records. Dietary knowledge and educational needs were measured by tools developed by the author. Results: The mean scores for the dietary knowledge and educational needs were 19.09± 3.48 and 36.17± 7.18, respectively. Many stroke patients had misconceptions about soy sauce, cholesterol, and fruits. The most needed items in dietary education was first identifying foods that are beneficial or harmful, and second, food interaction with medications. As for the results of multiple regressions, dietary knowledge was significantly associated with gender, educational attainment, monthly income, exercise, body mass index, and level of compliance to dietary therapy. Additionally, the educational needs were significantly related with educational attainment and employment. Conclusion For secondary prevention of stroke patients, education strategy considering dietary knowledge and educational needs of stroke patients should be established. Special attention is needed for stroke patients with a lower level of dietary knowledge and educational needs.

Simultaneous laparoscopic surgery for colorectal cancer and coexisting abdominal disease is shown to be feasible. However, simultaneous laparoscopic colorectal resection and nephrectomy is rarely documented, and its feasibility is unknown. We report two cases of simultaneous colorectal resection for colorectal cancer and nephrectomy. In the first case, a 71-year-old female underwent laparoscopic right hemicolectomy for an ascending colon cancer and left nephrectomy for a left non-functioning kidney. The second patient was a 77-year-old male with descending colon cancer and left renal cell carcinoma who underwent laparoscopic left hemicolectomy and left nephrectomy. The body mass indexes were 21.73 and 26.78 kg/m², respectively, and operation time was 275 and 395 minutes. Blood loss was 300 and 250 cc, and the postoperative hospital stay was 8 and 10 days. In both cases, there was no postoperative morbidity or mortality. Simultaneous laparoscopic resection for colorectal cancer and nephrectomy is a feasible and safe procedure.
Aged ; Body Mass Index ; Carcinoma, Renal Cell ; Colon, Ascending ; Colon, Descending ; Colorectal Neoplasms ; Female ; Humans ; Kidney ; Laparoscopy ; Length of Stay ; Male ; Mortality ; Nephrectomy*

Background: Gene therapy shows the ability to restore neuronal dysfunction via therapeutic gene expression. The efficiency of gene expression and delivery to hypoxic injury sites is important for successful gene therapy. Therefore, we established a gene/stem cell therapy system using neuron-specific enolase promoter and induced neural stem cells in combination with valproic acid to increase therapeutic gene expression in hypoxic spinal cord injury. Methods: To examine the effect of combined method on enhancing gene expression, we compared neuronal cell-inducible luciferase levels under normoxia or hypoxia conditions in induced neural stem cells with valproic acid. Therapeutic gene, vascular endothelial growth factor, expression with combined method was investigated in hypoxic spinal cord injury model. We verified gene expression levels and the effect of different methods of valproic acid administration in vivo. Results: The results showed that neuron-specific enolase promoter enhanced gene expression levels in induced neural stem cells compared to Simian Virus 40 promoter under hypoxic conditions. Valproic acid treatment showed higher gene expression of neuron-specific enolase promoter than without treatment. In addition, gene expression levels and cell viability were different depending on the various concentration of valproic acid. The gene expression levels were increased significantly when valproic acid was directly injected with induced neural stem cells in vivo. Conclusion In this study, we demonstrated that the combination of neuron-specific enolase promoter and valproic acid induced gene overexpression in induced neural stem cells under hypoxic conditions and also in spinal cord injury depending on valproic acid administration in vivo. Combination of valproic acid and neuron-specific enolase promoter in induced neural stem cells could be an effective gene therapy system for hypoxic spinal cord injury.

Background: s: Recently, alternative surrogate endpoints such as a 30% or 40% decline in estimated glomerular filtration rate (eGFR) or eGFR slope over 2 to 3 years have been proposed for predicting renal outcomes. However, the impact of GFR estimation methods on the accuracy and effectiveness of surrogate markers is unknown. Methods: We retrospectively enrolled participants in health screening programs at three hospitals from 1995 to 2009. We defined two different participant groups as YR1 and YR3, which had available 1-year or 3-year eGFR values along with their baseline eGFR levels. We compared the effectiveness of eGFR percentage change or slope to estimate end-stage renal disease (ESRD) risk according to two estimating equations (modified Modification of Diet in Renal Disease equation [eGFRm] and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation [eGFRc]) for GFR. Results: In the YR1 and YR3 groups, 9,971 and 10,171 candidates were enrolled and ESRD incidence during follow-up was 0.26% and 0.19%, respectively. The eGFR percentage change was more effective than eGFR slope in estimating ESRD risk, regardless of the method of estimation. A 40% of decline in eGFR was better than 30%, and a 3-year baseline period was better than a 1-year period for prediction accuracy. Although some diagnostic indices from the CKD-EPI equation were better, we found no significant differences in the discriminative ability and hazard ratios for incident ESRD between eGFRc and eGFRm in either eGFR percentage change or eGFR slope. Conclusion There were no significant differences in the prediction accuracy of GFR percentage change or eGFR slope between eGFRc and eGFRm in the general population.

Background: s: Recently, alternative surrogate endpoints such as a 30% or 40% decline in estimated glomerular filtration rate (eGFR) or eGFR slope over 2 to 3 years have been proposed for predicting renal outcomes. However, the impact of GFR estimation methods on the accuracy and effectiveness of surrogate markers is unknown. Methods: We retrospectively enrolled participants in health screening programs at three hospitals from 1995 to 2009. We defined two different participant groups as YR1 and YR3, which had available 1-year or 3-year eGFR values along with their baseline eGFR levels. We compared the effectiveness of eGFR percentage change or slope to estimate end-stage renal disease (ESRD) risk according to two estimating equations (modified Modification of Diet in Renal Disease equation [eGFRm] and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation [eGFRc]) for GFR. Results: In the YR1 and YR3 groups, 9,971 and 10,171 candidates were enrolled and ESRD incidence during follow-up was 0.26% and 0.19%, respectively. The eGFR percentage change was more effective than eGFR slope in estimating ESRD risk, regardless of the method of estimation. A 40% of decline in eGFR was better than 30%, and a 3-year baseline period was better than a 1-year period for prediction accuracy. Although some diagnostic indices from the CKD-EPI equation were better, we found no significant differences in the discriminative ability and hazard ratios for incident ESRD between eGFRc and eGFRm in either eGFR percentage change or eGFR slope. Conclusion There were no significant differences in the prediction accuracy of GFR percentage change or eGFR slope between eGFRc and eGFRm in the general population.

Background: Gene therapy shows the ability to restore neuronal dysfunction via therapeutic gene expression. The efficiency of gene expression and delivery to hypoxic injury sites is important for successful gene therapy. Therefore, we established a gene/stem cell therapy system using neuron-specific enolase promoter and induced neural stem cells in combination with valproic acid to increase therapeutic gene expression in hypoxic spinal cord injury. Methods: To examine the effect of combined method on enhancing gene expression, we compared neuronal cell-inducible luciferase levels under normoxia or hypoxia conditions in induced neural stem cells with valproic acid. Therapeutic gene, vascular endothelial growth factor, expression with combined method was investigated in hypoxic spinal cord injury model. We verified gene expression levels and the effect of different methods of valproic acid administration in vivo. Results: The results showed that neuron-specific enolase promoter enhanced gene expression levels in induced neural stem cells compared to Simian Virus 40 promoter under hypoxic conditions. Valproic acid treatment showed higher gene expression of neuron-specific enolase promoter than without treatment. In addition, gene expression levels and cell viability were different depending on the various concentration of valproic acid. The gene expression levels were increased significantly when valproic acid was directly injected with induced neural stem cells in vivo. Conclusion In this study, we demonstrated that the combination of neuron-specific enolase promoter and valproic acid induced gene overexpression in induced neural stem cells under hypoxic conditions and also in spinal cord injury depending on valproic acid administration in vivo. Combination of valproic acid and neuron-specific enolase promoter in induced neural stem cells could be an effective gene therapy system for hypoxic spinal cord injury.

OBJECTIVES: Stroke remains the second leading cause of death in Korea. This study was designed to estimate the crude, age-adjusted and age-specific incidence rates, as well as the case fatality rate of stroke, in Korea from 2011 to 2020. METHODS: We utilized data from the National Health Insurance Services from January 1, 2002 to December 31, 2020, to calculate incidence rates and 30-day and 1-year case fatality rates of stroke. Additionally, we determined sex and age-specific incidence rates and computed age-standardized incidence rates by direct standardization to the 2005 population. RESULTS: The crude incidence rate of stroke hovered around 200 (per 100,000 person-years) from 2011 to 2015, then surged to 218.4 in 2019, before marginally declining to 208.0 in 2020. Conversely, the age-standardized incidence rate consistently decreased by 25% between 2011 and 2020. When stratified by sex, the crude incidence rate increased between 2011 and 2019 for both sexes, followed by a decrease in 2020. Age-standardized incidence rates displayed a downward trend throughout the study period for both sexes. Across all age groups, the 30-day and 1-year case fatality rates of stroke consistently decreased from 2011 to 2019, only to increase in 2020. CONCLUSIONS Despite a decrease in the age-standardized incidence rate, the total number of stroke events in Korea continues to rise due to the rapidly aging population. Moreover, 2020 witnessed a decrease in incidence but an increase in case fatality rates.

Anticholinergic drugs block muscarinic receptors at the detrusor muscle of the bladder. It can cause urinary retention by contracting the bladder neck. Cases of hydronephrosis, bladder dilatation as a result of polydipsia while taking anticholinergic drugs have been reported, but very few cases of chronic renal failure can be found. We report a case of a polydipsic schizophrenic patient who, after taking anticholinergic drugs as antipsychotic drugs to treat his schizophrenia for a long time, presented with chronic renal failure due to functional obstructive uropathy in the absence of demonstrable anatomic causes of obstruction.
Antipsychotic Agents ; Cholinergic Antagonists ; Contracts ; Dilatation ; Humans ; Hydronephrosis ; Kidney Failure, Chronic ; Muscles ; Neck ; Polydipsia ; Receptors, Muscarinic ; Schizophrenia ; Urinary Bladder ; Urinary Retention

Aripiprazole (ARI) is a commonly prescribed medication used to treat schizophrenia and bipolar disorder. To date, there have been no studies regarding the molecular pathological and immunotoxicological profiling of aripiprazole. Thus, in the present study, we prepared two different formulas of aripiprazole [Free base crystal of aripiprazole (ARPGCB) and cocrystal of aripiprazole (GCB3004)], and explored their effects on the patterns of survival and apoptosis-regulatory proteins under acute toxicity and cytotoxicity test conditions. Furthermore, we also evaluated the modulatory activity of the different formulations on the immunological responses in macrophages primed by various stimulators such as lipopolysaccharide (LPS), pam3CSK, and poly(I:C) via toll-like receptor 4 (TLR4), TLR2, and TLR3 pathways, respectively. In liver, both ARPGCB and GCB3004 produced similar toxicity profiles. In particular, these two formulas exhibited similar phospho-protein profiling of p65/nuclear factor (NF)-kappaB, c-Jun/activator protein (AP)-1, ERK, JNK, p38, caspase 3, and bcl-2 in brain. In contrast, the patterns of these phospho-proteins were variable in other tissues. Moreover, these two formulas did not exhibit any cytotoxicity in C6 glioma cells. Finally, the two formulations at available in vivo concentrations did not block nitric oxide (NO) production from activated macrophage-like RAW264.7 cells stimulated with LPS, pam3CSK, or poly(I:C), nor did they alter the morphological changes of the activated macrophages. Taken together, our present work, as a comparative study of two different formulas of aripiprazole, suggests that these two formulas can be used to achieve similar functional activation of brain proteins related to cell survival and apoptosis and immunotoxicological activities of macrophages.
Aripiprazole ; Apoptosis ; Bipolar Disorder ; Brain ; Caspase 3 ; Cell Survival ; Glioma ; Liver ; Macrophages ; Nitric Oxide ; Schizophrenia ; Toll-Like Receptor 4