Since the coronavirus disease 2019 outbreak, telemedicine has become an important means of providing medical care worldwide. This study aims to highlight the implications of establishing telemedicine policies in Korea. Japan’s telemedicine policies were reviewed from the time of the first trial to the present official allowance.Current Concepts: Since telemedicine demonstration work began in 1971, telemedicine in Japan has advanced in four stages. The first stage was the operation of a remote regional comprehensive medical information system from 1971 to 1997. The second stage was when telemedicine was officially institutionalized from 1997 to 2018. The third stage was the time of expansion of telemedicine, from the announcement of the “Guidelines for the Implementation of Proper Online Care” in 2018 to when online first-time examinations were temporarily allowed in 2020. The fourth stage began in 2021 when the “Permanent Establishment of Special Cases for Online Care” was announced, and telemedicine has been officially allowed to supplement face-to-face care. Telemedicine usage was estimated to be about 53.65 million in 2021, and the total number of treatments in Japan in 2021 was estimated to be about 1.32 billion, accounting for about 4.1% of medical care.Discussion and Conclusion: For the Korean government to establish telemedicine, it needs to be promoted step by step through discussions with the medical community. Also, an appropriate medical remuneration system needs to be prepared along with guidelines reflecting the opinions of the medical community to secure the safety of telemedicine.

Korea has the most rapidly aging population in the world. Medical costs for the elderly are quickly increasing, which raises concerns about the sustainability of health insurance finances. Accordingly, the need to allocate limited medical resources efficiently has increased, with improving the fee schedule seen as an effective way to achieve this. Japan has experienced a super-aging society for at least 20 years prior to Korea and has been successful in improving its fee schedule. Korea’s fee schedule, however, needs to overcome the challenge of being relatively limited in type and simplicity.Current Concepts: The new patient consultation fee in Japan is the same regardless of the type of medical institution and is approximately 40% higher than found in Korea. In the case of established patient consultations, the fee for medical institutions with fewer than 200 beds are substantially higher than for large medical institutions, thereby suppressing re-examination at large hospitals. Japan’s additional points consist of 71 types of items, which is more diverse than Korea’s 28 types, and the additional points for children under six years of age, holidays, and late nights are set significantly higher than that found in Korea.Discussion and Conclusion: Japan designed its fee schedule to structurally reduce the consumption of medical resources and to effectively compensate for the behavior of medical providers. This policy is a standard which Korea’s fee schedule should aim for. In the future, it will be necessary to prepare measures to respond to the super-aging environment through detailed research concerning Japan’s fee schedule.

Epidemiological studies have suggested an association between pesticide exposure and Parkinson's disease. In this study, we examined the neurotoxicity of an organochlorine pesticide, heptachlor, in vitro and in vivo. In cultured SH-SY5Y cells, heptachlor induced mitochondria-mediated apoptosis. When injected into mice intraperitoneally on a subchronic schedule, heptachlor induced selective loss of dopaminergic neurons in the substantia nigra pars compacta. In addition, the heptachlor injection induced gliosis of microglia and astrocytes selectively in the ventral midbrain area. When the general locomotor activities were monitored by open field test, the heptachlor injection did not induce any gross motor dysfunction. However, the compound induced Parkinsonism-like movement deficits when assessed by a gait and a pole test. These results suggest that heptachlor can induce Parkinson's disease-related neurotoxicities in vivo.
Animals ; *Apoptosis ; Astrocytes/drug effects/pathology ; Cell Line, Tumor ; Cells, Cultured ; Dopaminergic Neurons/*drug effects/pathology ; Gait ; Heptachlor/*toxicity ; Humans ; *Locomotion ; Mice ; Neurotoxicity Syndromes/etiology/physiopathology ; Parkinsonian Disorders/chemically induced ; Pesticides/*toxicity ; Substantia Nigra/*drug effects/pathology/physiopathology

Successful hematopoietic stem cell transplantation (HSCT) involves the restoration of hematopoietic function after engraftment, arising from the differentiation and proliferation of hematopoietic stem cells. Several factors could influence the course of allogeneic-HSCT (allo-HSCT). Therefore, knowledge of serum proteome changes during the allo-HSCT period might increase the efficacy of diagnosis and disease prevention efforts. This study conducted proteomic analyses to find proteins that were significantly altered in response to allo-HSCT. Sera from five representative patients who underwent allo-HSCT were analyzed by 2-dimensional gel electrophoresis and liquid chromatography tandem mass spectrometry, and were measured on a weekly basis before and after allo-HSCT in additional 78 patients. Fourteen protein spots showing changes in expression were further examined, and most proteins were identified as acute phase proteins (APPs). Studies of 78 additional patients confirmed that C-reactive protein (CRP) and haptoglobin undergo expression changes during allo-HSCT and thus may have the potential to serve as representative markers of clinical events after allo-HSCT. Maximal CRP level affected the development of major transplant-related complications (MTCs) and other problems such as fever of unknown origin. Particularly, an increase in CRP level 21 days after allo-HSCT was found to be an independent risk factor for MTC. Maximal haptoglobin and haptoglobin level 14 days after allo-HSCT were predictive of relapses in underlying hematologic disease. Our results indicated that CRP and haptoglobin were significantly expressed during allo-HSCT, and suggest that their level can be monitored after allo-HSCT to assess the risks of early transplant-related complications and relapse.
Adolescent ; Adult ; Biological Markers ; C-Reactive Protein/*metabolism ; Female ; Haptoglobins/*metabolism ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Male ; Middle Aged ; Proteome/*metabolism ; Proteomics ; Transplantation Conditioning ; Transplantation, Homologous ; Young Adult

PURPOSE: The purpose of this study was to understand the experiences of interpersonal relationships of head nurses in interacting with others in general hospital settings. METHODS: The data were collected by individual in-depth interviews from seven head nurses and were analyzed using qualitative content analysis. RESULTS: Five major categories emerged and they represent a major strategy according to five different groups of interacting people. 'Establishing trust' was identified as the key strategy in dealing with patients and family members. 'Embracing with sisterly love' and 'helping with self-defense' were major strategies for subordinate nurses and physicians, respectively. 'Respecting and recognizing' was the main approach for other professionals such as dietitians and 'emphasizing rules and educating' were a major one for non-professionals. Head nurses paid more attention and made efforts in dealing with their subordinate nurses than with other groups of people, because they felt the most difficulty in their relationship with subordinate nurses. CONCLUSION: The results of the study showed that head nurses employ unique strategies in interacting with different groups of people to increase the efficiency of communication. This study would help nurse administrators establish an effective program for improving interpersonal relationships of head nurse.
Head ; Hospitals, General ; Humans ; Interdisciplinary Communication ; Interpersonal Relations ; Nurse Administrators ; Nursing, Supervisory ; Qualitative Research

Intraoperative hypothermia occurs frequently, but hyperthermia is relatively rare during general anesthesia. We experienced a case of hyperthermia during living donor liver transplantation that appeared to be significantly associated with biliary obstruction. A 65-year-old male patient was diagnosed with intrahepatic cholangiocarcinoma, and living donor liver transplantation was planned after confirmation of no metastasis via intraoperative frozen biopsy. Following resection of a segment of common bile duct for frozen biopsy, the surgeon clamped the common bile duct, and the patient's body temperature increased gradually to 39.5°C. As the congested bile was drained, the body temperature decreased to the normal range. This case report suggests that when a patient develops unexplained hyperthermia during hepatobiliary surgery or in a chance of biliary obstruction, clinicians should consider bile congestion as a possible reason for hyperthermia.
Aged ; Anesthesia, General ; Bile ; Biopsy ; Body Temperature ; Cholangiocarcinoma ; Common Bile Duct ; Estrogens, Conjugated (USP) ; Fever* ; Humans ; Hypothermia ; Liver Transplantation* ; Liver* ; Living Donors* ; Male ; Neoplasm Metastasis ; Reference Values

Although liver transplantation (LT) is the only effective treatment option for hepatopulmonary syndrome (HPS), the post-LT morbidity and mortality have been high for patients with severe HPS. We performed post-LT embolotherapy in a 10-year-old boy who had severe type I HPS preoperatively, but he failed to recover early from his hypoxemic symptoms after an LT. Multiple embolizations were then successfully performed on the major branches that formed the abnormal vascular structures. After the embolotherapy, the patient had symptomatic improvement and he was discharged without complications.
Child ; Combined Modality Therapy ; Echocardiography ; Embolization, Therapeutic/*methods ; Hepatopulmonary Syndrome/diagnosis/*therapy ; Humans ; *Liver Transplantation ; Male ; Oximetry ; Positron-Emission Tomography ; *Pulmonary Artery ; Tomography, X-Ray Computed

PURPOSE: To investigate optic nerve head size and retinal nerve fiber layer (RNFL) thickness according to refractive status and axial length. METHODS: In a cross-sectional study, 252 eyes of 252 healthy volunteers underwent ocular biometry measurement as well as optic nerve head and RNFL imaging by spectral-domain optical coherence tomography. Correlation and linear regression analyses were performed for all subjects. The magnification effect was adjusted by the modified axial length method. RESULTS: Disc area and spherical equivalent were positively correlated (r = 0.225, r² = 0.051, p = 0.000). RNFL thickness showed significant correlations with spherical equivalent (r = 0.359, r² = 0.129, p = 0.000), axial length (r = -0.262, r² = 0.069, p = 0.000), disc radius (r = 0.359, r² = 0.129, p = 0.000), and radius of the scan circle (r = -0.262, r² = 0.069, p = 0.000). After adjustment for the magnification effect, those relationships were reversed; RNFL thickness showed negative correlation with spherical equivalent and disc radius, and positive correlation with axial length and radius of the scan circle. The distance between the disc margin and the scan circle was closely correlated with RNFL thickness (r = -0.359, r² = 0.129, p = 0.000), which showed a negative correlation with axial length (r = -0.262, r² = 0.069, p = 0.000). CONCLUSIONS: Optic disc radius and RNFL thickness decreased in more severely myopic eyes, but they increased after adjustment for magnification effect. The error due to the magnification effect and optic nerve head size difference might be factors that should be considered when interpreting optical coherence tomography results.
Biometry ; Cross-Sectional Studies ; Healthy Volunteers ; Linear Models ; Methods ; Myopia* ; Nerve Fibers* ; Optic Disk* ; Optic Nerve* ; Radius ; Retinaldehyde* ; Tomography, Optical Coherence*

Purpose: In total mastectomy (TM), sentinel lymph node biopsy (SLNB) is recommended but can be omitted for breast-conserving surgery (BCS) in patients with ductal carcinoma in situ (DCIS). However, concerns regarding SLNB-related complications and their impact on quality of life exist. Consequently, further research is required to evaluate the role of axillary surgeries, including SLNB, in the treatment of TM. We aimed to explore the clinicopathological factors and outcomes associated with axillary surgery in patients with a final diagnosis of pure DCIS who underwent BCS or TM. Methods: We retrospectively analyzed large-scale data from the Korean Breast Cancer Society registration database, highlighting on patients diagnosed with pure DCIS who underwent surgery and were categorized into two groups: BCS and TM. Patients were further categorized into surgery and non-surgery groups according to their axillary surgery status. The analysis compared clinicopathological factors and outcomes according to axillary surgery status between the BCS and TM groups. Results: Among 18,196 patients who underwent surgery for DCIS between 1981 and 2022, 11,872 underwent BCS and 6,324 underwent TM. Both groups leaned towards axillary surgery more frequently for large tumors. In the BCS group, clinical lymph node status was associated with axillary surgery (odds ratio, 11.101; p = 0.003). However, in the TM group, no significant differences in these factors were observed. Survival rates did not vary between groups according to axillary surgery performance. Conclusion The decision to perform axillary surgery in patients with a final diagnosis of pure DCIS does not affect the prognosis, regardless of the breast surgical method.Furthermore, regardless of the breast surgical method, axillary surgery, including SLNB, should be considered for high-risk patients, such as those with large tumors. This may reduce unnecessary axillary surgery and enhance the patients’ quality of life.