With the rapid spread of coronavirus disease 2019 (COVID-19), a particularly sharp increase in the number of confirmed cases in Daegu and Gyeongbuk regions at the end of February, Korea faced an unprecedented shortage of medical resources, including hospital beds. To cope with this shortage, the government introduced a severity scoring system for patients with COVID-19 and designed a new type of quarantine facility for treating and isolating patients with mild symptoms out of the hospital, namely, the Residential Treatment Center (RTC). A patient with mild symptoms was immediately isolated in the RTC and continuously monitored to detect changes in symptoms. If the symptoms aggravate, the patient was transferred to a hospital. RTCs were designed by creating a quarantine environment in existing lodging facilities capable of accommodating > 100 individuals. The facilities were entirely divided into a clean zone (working area) and contaminated zone (patient zone), separating the space, air, and movement routes, and the staff wore level D personal protective equipment (PPE) in the contaminated zone. The staffs consisted of medical personnel, police officers, soldiers, and operation personnel, and worked in two or three shifts per day.Their duty was mainly to monitor the health conditions of quarantined patients, provide accommodations, and regularly collect specimens to determine if they can be released.For the past two months, RTCs secured approximately 4,000 isolation rooms and treated approximately 3,000 patients with mild symptoms and operated stably without additional spread of the disease in and out of the centers. Based on these experience, we would like to suggest the utilization of RTCs as strategic quarantine facilities in pandemic situations.

PURPOSE: To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS). MATERIALS AND METHODS: Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy. RESULTS: The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%). CONCLUSION: Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.
Academic Medical Centers ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Korea ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Treatment Outcome

Suicide has been a public health issue in many countries, and Korea has ranked highest suicide rate among Organization for Economic Cooperation and Development (OECD) countries over a decade. To address these issues, we updated the recent trends in suicidal ideation and suicide attempts among Korean adults followed by previous data observation. We used data from five sources: Korean National Health and Nutrition Examination (KNHANES, '07–12, '13, '15–16), Korean Community Health Survey (KCHS, '08–09, '13), Korean Wealth Panel Study (KOWEPS, '12–16), Korea Health Panel Survey (KHP, '10–13), and cause of death data from Statistics Korea ('07–16). We used weighted frequencies and trend tests. The rate of suicidal ideation as recent year was 5.10% (KNHANES, '15), 8.95% (KCHS, '13), 2.08% (KOWEPS, '16), and 5.39% (KHP, '13). That of suicide attempts as recent year was 0.59% (KNHANES, '16), 0.41% (KCHS, '13), and 0.08% (KOWEPS, '16). Annual percentage change of suicidal ideation was −2.80% (KNHANES, '07–12), 5.78% (KNHANES, '13–15), 0.62% (KCHS, '08–13), −8.50% (KOWEPS, '12–16), and −10.94% (KHP, '10–13). Annual percentage change of suicide attempts was −3.84% (KNHANES, '07–12), 2.26% (KNHANES, '13–16), −2.53% (KCHS, '08–13), and −20.22% (KOWEPS, '12–16). Annual percentage change of death by intentional self-harm was −0.49% (Statistics Korea, '07–16). Individuals who had lower income level were more likely to experience suicidal ideation and suicide attempts. According to these results, the rate of suicidal ideation and suicide attempts showed the decreasing tendency. However, the suicide rate of Korea has remained higher than that of OECD countries. Thus, continuous data observation and effective policies on suicide are needed.
Adult ; Cause of Death ; Health Surveys ; Humans ; Korea ; Organisation for Economic Co-Operation and Development ; Public Health ; Suicidal Ideation ; Suicide

OBJECTIVES: We aimed to study the effects of the coronavirus disease 2019 (COVID-19) pandemic on adolescents’ mental health in Korea. METHODS: We used data from the Korea Youth Risk Behavior Survey 2018-2021 with 227,139 students aged 12-18 years. We estimated the differences in depressive symptoms, suicidal ideation, and stress perception before (2018-2019) and during (2020-2021) the pandemic, as well as before (2019), the first year (2020) of, and the second year (2021) of the pandemic. We also examined whether COVID-19 is statistically associated with mental health. RESULTS: In both male and female adolescents, the prevalence of depressive symptoms, suicidal ideation, and stress perception was higher in the “not living with family,” “low household economic status,” and “self-rated unhealthy status” subgroups. The prevalence of depressive symptoms and stress perception was higher in middle school students. Adolescents were less likely to experience depressive symptoms (adjusted odds ratio [aOR], 0.86; 95% confidence interval [CI], 0.83 to 0.89), suicidal ideation (aOR, 0.80; 95% CI, 0.76 to 0.83), and stress perception (aOR, 0.76; 95% CI, 0.74 to 0.79) in 2020 than in 2019. However, there were more depressive symptoms (aOR, 1.06; 95% CI, 1.02 to 1.09), suicidal ideation (aOR, 1.15; 95% CI, 1.10 to 1.21), and stress perception (aOR, 1.19; 95% CI, 1.16 to 1.23) in 2021 than in 2020. CONCLUSIONS The COVID-19 pandemic had positive impacts on mental health of adolescents in its early stages but has had negative impacts as the pandemic continues. Attention should be paid to adolescents who are particularly vulnerable to the mental health effects of the pandemic.

PURPOSE: Short sleep duration is associated with obesity. Urinary 6-sulfatoxymelatonin (6-OHMS), the principal metabolite of melatonin, is closely related with sleep. We evaluated the difference in urinary 6-OHMS levels between obese girls and normal weight girls, and the relationship of urinary 6-OHMS with other hormones regulating body weight and metabolism. METHODS: A total of 79 girls (6.3 to 12.4 years) were included in this study, of whom 34 were obese; 15, overweight; and 30, normal-weight. We examined their pubertal status and bone age. Fasting serum levels of total ghrelin, leptin, insulin, and first morning urinary 6-OHMS were measured. Homeostatic model assessment-insulin resistance (HOMA-IR) was calculated from the fasting insulin and glucose levels. RESULTS: There was no significant difference in the creatinine adjusted 6-OHMS levels between the obese girls and the control group. Urinary 6-OHMS did not show any correlations with body mass index (BMI), BMI percentile, total ghrelin, leptin, and HOMA-IR. Negative correlations were found between urinary 6-OHMS levels and chronological and bone ages. CONCLUSION: Our results suggest that melatonin production is not reduced consistently in obese girls.
Body Mass Index ; Body Weight ; Child ; Creatinine ; Fasting ; Ghrelin ; Glucose ; Humans ; Insulin ; Leptin ; Melatonin ; Obesity

Spinal accessory neuropathy is commonly caused by iatrogenic injury or secondary to trauma or infection. Nevertheless, the tumor related palsy is rare. We present a case of an 18-year-old male patient suffering from paralysis of his right trapezius and sternocleidomastoid muscle. An electrophysiologic diagnostic study confirmed the spinal accessory neuropathy of the proximal segment. In addition, magnetic resonance imaging showed the location of tumor on the jugular foramen. However, the type of the tumor was not confirmed through biopsy because the patient refused surgical procedure. Based on the study, it is hypothesized that the tumor located on the jugular foramen should be considered as a cause of the spinal accessory nerve of the proximal segment.
Accessory Nerve ; Biopsy ; Glomus Jugulare ; Humans ; Magnetic Resonance Imaging ; Male ; Muscles ; Paralysis ; Stress, Psychological

PURPOSE: The aim of this study was to evaluate the efficacy of pamidronate therapy in children and adolescents with secondary osteoporosis. METHODS: Nine patients (7 males, 2 females, 13.2 +/- 2.5 years, 10.1-17.4 years) with secondary osteoporosis who had a history of severe bone pain and/or fracture were enrolled. Intravenous pamidronate 1.5 mg/kg (0.5 mg/kg for 3 consecutive days) was given every 6 to 8 weeks for 0.86 +/- 0.15 years (6 or 8 cycles). Bone mineral density (BMD) in lumbar spine and femoral neck and their Z-scores were measured before treatment, after the fourth and last cycle (sixth or eighth cycle). RESULTS: Underlying diseases were as follows; neurofibromatosis type 1 (n = 2), epilepsy with/without cerebral palsy (N=2), autoimmune disease treated with steroid (n = 2), hematologic malignancy (n = 3). Bone pain was relieved in most of the patients after the first cycle of treatment, and no more fracture occurred thereafter. There was a significant increase in BMD Z-score of the lumbar spine and femoral neck after the last cycle of therapy, compared to baseline values (from -3.91 +/- 1.79 to 1.86 +/- 1.18, in L1-4 and -3.71 +/- 1.83 to -2.53 +/- 1.77 for femoral neck; P = 0.008 and 0.011, respectively). However, there was no significant change in BMD Z-scores between the fourth cycle and the last cycle. Fever developed in 7 out of 9 patients (77.8%), which was relieved by antipyretics. Total serum levels of calcium and phosphorus were significantly decreased (calcium, P = 0.008; phosphorus, P = 0.015) after pamidronate therapy, and three of them experienced symptomatic hypocalcemia during the first cycle. The growth velocity was normal during follow-up periods (mean, 4.47 +/- 1.69 years; range, 1.05 to 6.77 years). CONCLUSION: In conclusion, pamidronate can be administered to the patients with secondary osteoporosis, relieving the symptoms and signs effectively and safely. However, its side effects should be monitored during treatment.
Adolescent ; Antipyretics ; Autoimmune Diseases ; Bone Density ; Calcium ; Cerebral Palsy ; Child ; Diphosphonates ; Epilepsy ; Female ; Femur Neck ; Fever ; Follow-Up Studies ; Hematologic Neoplasms ; Humans ; Hypocalcemia ; Male ; Neurofibromatosis 1 ; Osteoporosis ; Phosphorus ; Spine

OBJECTIVE: South Korea has an increasing aging population; thus, the management of depressive symptoms in elderly individuals is important. In this population, fewer social contacts might be a risk factor for depressive symptoms. We examined associations between the frequency of social contacts and depressive symptoms among elderly Koreans and factors associated with these symptoms. METHODS: Data from 62,845 individuals over 65 years of age enrolled in the 2015 Community Health Survey were used in this study. Logistic regression was performed to test the association between depressive symptoms and social contacts. RESULTS: Individuals who had contact with neighbors less than once a week were more likely to experience depressive symptoms [odds ratio (OR): 1.22, 95% confidence interval (CI): 1.10–1.35] compared to those who had contact more than once a week. Individuals who had frequent contact with neighbors and friends, neighbors and relatives, or all three groups were significantly less likely to experience depressive symptoms. CONCLUSION: The frequency of social contact with neighbors was the most powerful factor associated with elderly adults’ depressive symptoms among other social relationships. Additional senior welfare centers may facilitate the ability of elderly individuals in meeting neighbors, thereby reducing the risk of depressive symptoms.
Aged* ; Aging ; Depression* ; Friends ; Health Surveys ; Humans ; Korea ; Logistic Models ; Risk Factors

Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) are differentiated by the presence of cardiometabolic risk factors (CMRFs) and insulin resistance (IR). This study aimed to evaluate the prevalence and clinical characteristics of MHO in Korean children and adolescents and to investigate the anthropometric, laboratory, and lifestyle predictors of MHO. This study included data from 530 obese subjects, aged 10–19 years, obtained from the Fourth Korea National Health and Nutrition Examination Survey. Subjects were classified into MHO and MUO groups according to the presence of CMRF (MHO(CMRF)/MUO(CMRF)) and degree of IR (MHO(IR)/MUO(IR)). Demographic, anthropometric, cardiometabolic, and lifestyle factors were compared between the groups. Logistic regression analysis and receiver operating characteristic curve analysis were performed to identify factors that predicted MHO. The prevalence of MHO(CMRF) and MHO(IR) in obese Korean youth was 36.8% (n = 197) and 68.8% (n = 356), respectively. CMRF profiles were significantly less favorable in MUO children. Longer and more vigorous physical activity and less protein intake were associated with MHO(CMRF) phenotype. The best predictors of MHO(CMRF) and MHO(IR) were waist circumference (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.77–0.88; P < 0.001) and body mass index (BMI) standard deviation score (OR, 0.24; 95% CI, 0.15–0.39; P < 0.001), respectively. The prevalence of MHO differed depending on how it was defined. To adequately manage obesity in youth, the approach to individuals with MHO and MUO should be personalized due to variation in clinical characteristics. Longitudinal studies are needed to evaluate long-term consequences of MHO.
Adolescent* ; Body Mass Index ; Child* ; Humans ; Insulin Resistance ; Korea* ; Life Style ; Logistic Models ; Longitudinal Studies ; Motor Activity ; Nutrition Surveys* ; Obesity ; Obesity, Metabolically Benign* ; Phenotype ; Prevalence* ; Risk Factors ; ROC Curve ; Waist Circumference

BACKGROUND: Tauopathies, a class of neurodegenerative diseases that includes Alzheimer's disease (AD), are characterized by the deposition of neurofibrillary tangles composed of hyperphosphorylated tau protein in the human brain. As abnormal alterations in histone acetylation and methylation show a cause and effect relationship with AD, we investigated the role of several Jumonji domain-containing histone demethylase (JHDM) genes, which have yet to be studied in AD pathology. METHODS: To examine alterations of several JHDM genes in AD pathology, we performed bioinformatics analyses of JHDM gene expression profiles in brain tissue samples from deceased AD patients. Furthermore, to investigate the possible relationship between alterations in JHDM gene expression profiles and AD pathology in vivo, we examined whether tissue-specific downregulation of JHDM Drosophila homologs (kdm) can affect tauR406W-induced neurotoxicity using transgenic flies containing the UAS-Gal4 binary system. RESULTS: The expression levels of JHDM1A, JHDM2A/2B, and JHDM3A/3B were significantly higher in postmortem brain tissue from patients with AD than from non-demented controls, whereas JHDM1B mRNA levels were downregulated in the brains of patients with AD. Using transgenic flies, we revealed that knockdown of kdm2 (homolog to human JHDM1), kdm3 (homolog to human JHDM2), kdm4a (homolog to human JHDM3A), or kdm4b (homolog to human JHDM3B) genes in the eye ameliorated the tauR406W-engendered defects, resulting in less severe phenotypes. However, kdm4a knockdown in the central nervous system uniquely ameliorated tauR406W-induced locomotion defects by restoring heterochromatin. CONCLUSION: Our results suggest that downregulation of kdm4a expression may be a potential therapeutic target in AD.
Acetylation ; Alzheimer Disease ; Brain ; Central Nervous System ; Computational Biology ; Diptera ; Down-Regulation ; Drosophila melanogaster ; Drosophila ; Heterochromatin ; Histones ; Humans ; Locomotion ; Methylation ; Neurodegenerative Diseases ; Neurofibrillary Tangles ; Pathology ; Phenotype ; RNA, Messenger ; tau Proteins ; Tauopathies ; Transcriptome