When incorporating artificial intelligence (AI) based on medical big data into the clinical and research settings, it is important to consider the associated ethical philosophy in addition to medical behavior.Simply improving the processing speed and increasing the amount of data will not suffice. Instead, it is necessary to continuously provide a direction for AI progress in medical algorithms that are required in order to make use of medical big data. To integrate AI with healthcare research and medical practice, it is essential that AI algorithms are reviewed by experienced medical staff. Additionally, the question regarding which levels of data can or cannot be trusted by medical staff needs to be answered. AI algorithms are best suited to provide assistance (decision-supporting) during the decision-making process. Hence, if more AI algorithms are implemented through such a series of processes, skilled medical personnel can play large roles, and their roles can be subcategorized. Furthermore, based on the medical value of AI, health care providers should have a role in determining the reasonableness and suitability of AI algorithms.

When incorporating artificial intelligence (AI) based on medical big data into the clinical and research settings, it is important to consider the associated ethical philosophy in addition to medical behavior.Simply improving the processing speed and increasing the amount of data will not suffice. Instead, it is necessary to continuously provide a direction for AI progress in medical algorithms that are required in order to make use of medical big data. To integrate AI with healthcare research and medical practice, it is essential that AI algorithms are reviewed by experienced medical staff. Additionally, the question regarding which levels of data can or cannot be trusted by medical staff needs to be answered. AI algorithms are best suited to provide assistance (decision-supporting) during the decision-making process. Hence, if more AI algorithms are implemented through such a series of processes, skilled medical personnel can play large roles, and their roles can be subcategorized. Furthermore, based on the medical value of AI, health care providers should have a role in determining the reasonableness and suitability of AI algorithms.

Panic disorder is one of the chronic and disabling anxiety disorders. There has been evidence for either genetic heterogeneity or complex inheritance, with environmental factor interactions and multiple single genes, in panic disorder's etiology. Linkage studies have implicated several chromosomal regions, but no research has replicated evidence for major genes involved in panic disorder. Researchers have suggested several neurotransmitter systems are related to panic disorder. However, to date no candidate gene association studies have established specific loci. Recently, researchers have emphasized genome-wide association studies. Results of two genome-wide association studies on panic disorder failed to show significant associations. Evidence exists for differences regarding gender and ethnicity in panic disorder. Increasing evidence suggests genes underlying panic disorder overlap, transcending current diagnostic boundaries. In addition, an anxious temperament and anxiety-related personality traits may represent intermediate phenotypes that predispose to panic disorder. Future research should focus on broad phenotypes, defined by comorbidity or intermediate phenotypes. Genome-wide association studies in large samples, studies of gene-gene and gene-environment interactions, and pharmacogenetic studies are needed.
Catechol O-Methyltransferase/genetics ; Cholecystokinin/genetics ; Genetic Loci ; *Genome-Wide Association Study ; Humans ; Monoamine Oxidase/genetics ; Panic Disorder/*genetics

There is growing evidence of poor health-related quality of life (HRQOL) in patients with panic disorder (PD). However, little is known about the factors affecting HRQOL in patients with PD. The authors examined whether 5-HTTLPR tri-allelic approach and Cathechol-O-methyltransferase (COMT) Val(158)Met polymorphism can predict HRQOL in patients with PD controlling for sociodemographic factors and disorder-related symptom levels. The sample consisted of 179 patients with PD consecutively recruited from an outpatient clinic and age- and gender ratio-matched 110 healthy controls. The SF-36 was used to assess multiple domains of HRQOL. Hierarchical multiple regression analysis was performed to determine the independent effect of the 5-HTTLPR and COMT Val(158)Met on the SF-36 in panic patients. Patients with PD showed lowered HRQOL in all sub-domains of the SF-36 compared to healthy controls. The 5-HTTLPR independently and additively accounted for 2.2% of variation (6.7% of inherited variance) of perceived general health and the COMT Val(158)Met independently and additively accounted for 1.5% of variation (5.0% of inherited variance) of role limitation due to emotional problems in patient group. The present study suggests that specific genetic polymorphisms are associated with certain domains of HRQOL and provides a new insight on exploring the factors that predict HRQOL in patients with PD.
Adult ; Age Factors ; Alleles ; Case-Control Studies ; Catechol O-Methyltransferase/*genetics ; Female ; Genotype ; Humans ; Male ; Middle Aged ; Panic Disorder/genetics/*pathology ; Polymorphism, Single Nucleotide ; *Quality of Life ; Regression Analysis ; Serotonin Plasma Membrane Transport Proteins/*genetics ; Sex Factors

Objective: Despite multiple drugs available, a large proportion of patients with generalized anxiety disorder (GAD) do not show adequate response and remission. Thus, additional novel pharmacological agents are needed to increase treatment option for GAD. We aimed to investigate efficacy and safety of agomelatine in the treatment of GAD by conducting a meta-analysis. Methods: An extensive search of multiple databases and clinical trial registries were conducted. Mean change in total scores on Hamilton Anxiety Rating Scale (HAM-A) from baseline to endpoint was our primary outcome measure. Secondary efficacy measures included response and remission rates, as defined by a 50% or greater reduction in HAM-A total scores and a score of 7 or less in HAM-A total scores at study endpoint respectively. Results: Four published double blinded, randomized, placebo-controlled trials were included in this meta-analysis. Agomelatine more significantly (standardized mean difference = −0.56, 10.9758/cpn.2020.18.3.423 = 0.004) improved HAM-A total scores than placebo. The odds ratios (ORs) of agomelatine over placebo for response and remission rates were 3.75 (p ＜ 0.00001) and 2.74 (p ＜ 0.00001), respectively. Agomelatine was generally well tolerated with insignificance in dropout rate, somnolence, headache, nasopharyngitis, and dizziness compared with placebo. However, agomelatine showed significantly higher incidence of liver function increment (OR = 3.13, p = 0.01) and nausea (OR = 3.27, p = 0.02). Conclusion We showed that agomelatine may be another treatment option in patients with GAD. However, the results should be interpreted and translated into clinical practice with caution because the meta-analysis was based on limited numbers of clinical trials.

OBJECTIVE: Panic disorder (PD) is frequently comorbid with insomnia, which could exacerbate panic symptoms and contribute to PD relapse. Research has suggested that characteristics are implicated in both PD and insomnia. However, there are no reports examining whether temperament and character affect insomnia in PD. Thus, we examined the relationship between insomnia and personality characteristics in PD patients. METHODS: Participants were 101 patients, recruited from 6 university hospitals in Korea, who met the DSM-IV-TR criteria for PD. We assessed sleep outcomes using the sleep items of 17-item Hamilton Depression Rating Scale (HAMD-17)(item 4=onset latency, item 5=middle awakening, and item 6=early awakening) and used the Cloninger's Temperament and Character Inventory-Revised-Short to assess personality characteristics. To examine the relationship between personality and insomnia, we used analysis of variance with age, sex, and severity of depression (total HAMD scores minus sum of the three sleep items) as the covariates. RESULTS: There were no statistical differences (p>0.1) in demographic and clinical data between patients with and without insomnia. Initial insomnia (delayed sleep onset) correlated to a high score on the temperamental dimension of novelty seeking 3 (NS3)(F1,96=6.93, p=0.03). There were no statistical differences (p>0.1) in NS3 between patients with and without middle or terminal insomnia. CONCLUSION: The present study suggests that higher NS3 is related to the development of initial insomnia in PD and that temperament and character should be considered when assessing sleep problems in PD patients.
Depression ; Hospitals, University ; Humans ; Korea ; Panic ; Panic Disorder ; Recurrence ; Sleep Initiation and Maintenance Disorders ; Temperament

Arcanobacterium haemolyticum is a beta-hemolytic coryneform bacillus. It has been implicated as an etiologic agent of non-streptococcal pharyngitis and less frequently a cause of skin and wound infections, osteomyelitis, pneumonia, endocarditis, sepsis, and central nervous system infections. We describe a case of A. hemolyticum sepsis reported for the first time in Korea. A 61-year-old man with a diabetic foot was admitted due to a high fever. Three sets of blood cultures taken at the emergency room yielded coryneform bacilli. The organism was beta-hemolytic on blood agar plate, catalase-negative, and non-motile. It was identified as A. haemolyticum by Rapid CB Plus (Remel, Kansas, USA) and API Coryne (BioMerieux SA, Marcy l`Etoile, France) and confirmed by CAMP inhibition reaction. It was susceptible to penicillin, ceftriaxone, erythromycin, ciprofloxacin, and vancomycin by the disk diffusion method using the breakpoint criteria of National Committee for Clinical Laboratory Standards for streptococci other than Streptococcus pneumoniae. The patient was improved with partial amputation of the right big toe and antimicrobial therapy with ampicillin/sulbactam. If Arcanobacterium is isolated from normally sterile sites or culture specimens properly collected from infected tissues, it should be identified to the species level. Commercial biochemical test kits specialized in corynebacteria and CAMP test are useful for species identification of A. haemolyticum.
Agar ; Amputation ; Arcanobacterium* ; Bacillus ; Ceftriaxone ; Central Nervous System Infections ; Ciprofloxacin ; Diabetic Foot ; Diffusion ; Emergency Service, Hospital ; Endocarditis ; Erythromycin ; Fever ; Humans ; Kansas ; Korea ; Middle Aged ; Osteomyelitis ; Penicillins ; Pharyngitis ; Pneumonia ; Sepsis* ; Skin ; Streptococcus pneumoniae ; Toes ; Vancomycin ; Wound Infection

BACKGROUND AND OBJECTIVES: Differentiation and de-differentiation of vascular smooth muscle cells (VSMCs) are important events in atherosclerosis and restenosis after angioplasty. MicroRNAs are considered a key regulator in cellular processes such as differentiation, proliferation, and apoptosis. Here, we report the role of new miR-18a-5p microRNA and its downstream target genes in VSMCs and in a carotid balloon injury model. MATERIALS AND METHODS: Expression of miR-18a-5p and its candidate genes was examined in VSMCs and in a carotid artery injury model by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and microRNA microarray analysis. VSMC differentiation marker genes including smooth muscle (SM) alpha-actin and SM22alpha were determined by Western blot, qRT-PCR, and a SM22alpha promoter study. Gene overexpression or knockdown was performed in VSMCs. RESULTS: miR-18a-5p was upregulated in the rat carotid artery at the early time after balloon injury. Transfection of the miR-18a-5p mimic promoted the VSMC differentiation markers SM alpha-actin and SM22alpha. In addition, miR-18a-5p expression was induced in differentiated VSMCs, whereas it decreased in de-differentiated VSMCs. We identified syndecan4 as a downstream target of miR-18-5p in VSMCs. Overexpression of syndecan4 decreased Smad2 expression, whereas knockdown of syndecan4 increased Smad2 expression in VSMCs. Finally, we showed that Smad2 induced the expression of VSMC differentiation marker genes in VSMCs. CONCLUSION: These results indicate that miR-18a-5p is involved in VSMC differentiation by targeting syndecan4.
Actins ; Angioplasty ; Animals ; Antigens, Differentiation ; Apoptosis ; Atherosclerosis ; Blotting, Western ; Carotid Arteries ; Carotid Artery Injuries ; Cell Differentiation* ; Microarray Analysis ; MicroRNAs* ; Muscle, Smooth ; Muscle, Smooth, Vascular* ; Polymerase Chain Reaction ; Rats ; Smad2 Protein ; Syndecan-4* ; Transfection

Objective: We performed a meta-analysis of randomized double-blinded placebo controlled trials (DB-RCTs) to investigate efficacy and safety of intranasal esketamine in treating major depressive disorder (MDD) including treatment resistant depression (TRD) and major depression with suicide ideation (MDSI). Methods: Mean change in total scores on Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to different time-points were our primary outcome measure. Secondary efficacy measures included rate of remission of depression and resolution of suicidality. Results: Eight DB-RCTs (seven published and one un-published) covering 1,488 patients with MDD were included. Esketamine more significantly improved MADRS total scores than placebo starting from 2−4 hours after the first administration (standardized mean difference, −0.41 [95% CI, −0.58 to −0.25], p ＜ 0.00001), and this superiority maintained until end of double-blinded period (28 days). Sub-group analysis showed that superior antidepressant effects of esketamine over placebo in TRD and MDSI was observed from 2−4 hours, which was maintained until 28 days. Resolution of suicide in MDSI was also greater for esketamine than for placebo at 2−4 hours (OR of 2.04, 95% CIs, 1.37 to 3.05, p = 0.0005), but two groups did not statistically differ at 24 hours and day 28. Total adverse events (AEs), and other common AEs including dissociation, blood pressure increment, nausea, vertigo, dysgeusia, dizziness, and somnolence were more frequent in esketamine than in placebo group. Conclusion Esketamine showed rapid antidepressant effects in patients with MDD, including TRD and MDSI. The study also suggested that esketamine might be associated with rapid anti-suicidal effects for patients with MDSI.

Objective: Despite a high prevalence of dementia in older adults hospitalized with severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2), or so called COVID-19, research investigating association between preexisting diagnoses of dementia and prognosis of COVID-19 is scarce. We aimed to investigate treatment outcome of patients with dementia after COVID-19. Methods: We explored a nationwide cohort with a total of 2,800 subjects older than 50 years who were diagnosed with COVID-19 between January and April 2020. Among them, 223 patients had underlying dementia (dementia group). We matched 1:1 for each dementia- non-dementia group pair yielding 223 patients without dementia (no dementia group) using propensity score matching. Results: Mortality rate after COVID-19 was higher in dementia group than in no dementia group (33.6% vs. 20.2%, p=0.002). Dementia group had higher proportion of patients requiring invasive ventilatory support than no dementia group (34.1% vs. 22.0%, p=0.006). Multivariable analysis showed that dementia group had a higher risk of mortality than no dementia group (odds ratio=3.05, p<0.001). We also found that patients in dementia group had a higher risk of needing invasive ventilatory support than those in no dementia group. Conclusion Our results suggest that system including strengthen quarantines are required for patients with dementia during the COVID- 19 pandemic.