Regulatory T cells (Treg) naturally rein in immune attacks, and they can inhibit rejection of transplanted organs and even reverse the progression of autoimmune diseases in mice. The initial safety trials of Treg against graft-versus-host disease (GVHD) provided evidence that the adoptive transfer of Treg is safe and capable of limiting disease progression. Supported by such evidence, numerous clinical trials have been actively investigating the efficacy of Treg targeting autoimmune diseases, type I diabetes, and organ transplant rejection, including kidney and liver. The limited quantity of Treg cells harvested from peripheral blood and subsequent in vitro culture have posed a great challenge to large-scale clinical application of Treg; nevertheless, the concept of CAR (chimeric antigen receptor)-Treg has emerged as a potential resolution to the problem. Recently, two CAR-T therapies, tisagenlecleucel and axicabtagene ciloleucel, were approved by the US FDA for the treatment of refractory or recurrent acute lymhoblastic leukemia. This approval could serve as a guideline for the production protocols for other genetically engineered T cells for clinical use as well. The phase I and II clinical trials of these agents has demonstrated that genetically engineered and antigen-targeting T cells are safe and efficacious in humans. In conclusion, both the promising results of Treg cell therapy from the clinical studies and the recent FDA approval of CAR-T therapies are paving the way for CAR-Treg therapy in clinical use.
Adoptive Transfer ; Animals ; Autoimmune Diseases ; Cell- and Tissue-Based Therapy* ; Disease Progression ; Graft vs Host Disease ; Humans ; In Vitro Techniques ; Kidney ; Leukemia ; Liver ; Mice ; T-Lymphocytes ; T-Lymphocytes, Regulatory* ; Transplantation ; Transplants

BACKGROUND: The purpose of this study is to measure the Korean health literacy level and to analyse its gaps according to the factors of socioeconomic and health status and health behaviors. Based on this, policy implications were reviewed to improve the understandability on health information and to reduce the gap among socioeconomic groups. METHODS: HLS-EU-Q47, a tool developed by the European Health Literacy Project, was used to conduct a face-to-face interview survey on the health literacy for the samples from general population. RESULTS: The public general health literacy (HL) index was 34.5 out of 50. HL is consisted of three sub-dimensions: healthcare (HC-HL), disease prevention (DP-HL), and health promotion (HP-HL). And a HL analysis found scores of 34.7 points for HC-HL, 35.4 points for DP-HL, and 33.3 points for HP-HL. The level of all HL was different according to socioeconomic characteristics and health behavior. CONCLUSION: Based on the results of this study, more research activities on health-related literacy need to be conducted, and monitoring system on the HL level needs to be developed and implemented. In addition, a program to improve HL levels needs to be developed in order to strengthen the basis for a more sustainable healthcare system as an agenda with national health policy priority.
Consumer Health Information ; Delivery of Health Care ; Health Behavior ; Health Literacy ; Health Policy ; Health Promotion ; Literacy

PURPOSE: Inadequate calorie intake is one of the most important causes of nonorganic failure to thrive (NOFTT) and is thought to lead to multiple micronutrient deficiencies. However, there have been few studies on NOFTT and micronutrients. The aim of this study was to evaluate the micronutrient status of children with NOFTT. METHODS: We conducted a retrospective cohort study in 161 children (106 with NOFTT and 55 health controls) at a single institution. Data on weight for age, height for age, body mass index, and biochemical parameters, indicating the children's nutritional and micronutrient status were reviewed via electronic medical records, and the two groups were compared. RESULTS: Except inorganic phosphate levels, no statistically significant differences were seen in the laboratory findings indicating the children's nutritional and micronutrient status; notably, the inorganic phosphate levels were within the normal range in both groups. We then compared the severe NOFTT (weight for age below the first percentile) and control groups; however, no statistically significant differences were seen for any of the measured parameters. CONCLUSION: Most children with NOFTT in this study had normal micronutrient levels and other laboratory findings. Therefore, element deficiencies should not be considered a natural consequence of NOFTT or in healthy children. Close monitoring and additional evaluations are needed.
Body Mass Index ; Child ; Cohort Studies ; Electronic Health Records ; Failure to Thrive ; Humans ; Micronutrients ; Reference Values ; Retrospective Studies

Purpose: This study investigated the characteristics and treatment outcomes of patients who visited the emergency department due to intoxication and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on their visits. Methods: A retrospective study was conducted using data from the National Emergency Department Information System (NEDIS) on patients who visited the emergency department due to intoxication between January 2014 and December 2020. In total, 277,791 patients were included in the study, and their demographic and clinical data were analyzed. A model was created from 2014 to 2019 and applied to 2020 (i.e., during the COVID-19 pandemic) to conduct a time series analysis distinguishing between unexpected accidents and suicide/self-harm among patients who visited the emergency department. Results: The most common reason for visiting the emergency department was unintentional accidents (48.5%), followed by self-harm/suicide attempts (43.8%). Unexpected accident patients and self-harm/suicide patients showed statistically significant differences in terms of sex, age group, hospitalization rate, and mortality rate. The time series analysis showed a decrease in patients with unexpected accidents during the COVID-19 pandemic, but no change in patients with suicide/self-harm. Conclusion Depending on the intentionality of the intoxication, significant differences were found in the age group, the substance of intoxication, and the mortality rate. Therefore, future analyses of patients with intoxication should be stratified according to intentionality. In addition, the time series analysis of intentional self-harm/suicide did not show a decrease in 2010 in the number of patients, whereas a decrease was found for unintentional accidents.

OBJECTIVES: The aims of the study were to make a questionnaire for assessing physical workloads and to evaluate its reliability and validity. METHODS: A total of 220 workers (foundry workers 30, large vehicle assemblers 30, shipyard workers 75, and automobile manufacturers 80) completed a self-administered questionnaire and took examinations for physical work capacity and working heart rate. We excluded data with insufficient responses or incorrect physical work capacity and working heart rate. Finally, the data of 154 workers (70.0%) were used for our study. In order to evaluate the reliability and validity of the questionnaire, we used statistical analyses including the scaling assumption test and a comparison with the objective tool for physical workload which was evaluated by working energy expenditure. RESULTS: The items of the questionnaire in the same categories had close distribution in the evaluation of the scaling assumption. The item internal consistency was 0.41-0.73 for posture factor, and 0.62-0.79 for non-posture factor. The item discriminate validity was 100%. Cronbach's alphacoefficient of the total items was 0.73 (0.58 for posture factor and 0.74 for nonposture factor). In the correlation between working energy expenditure and questions, general physical activity (p=0.008), proportion of the workday with hands above shoulder (p=0.002), proportion of the workday with trunk bent (p=0.028), proportion of the workday with awkward posture (p=0.048), sweating after work (p=0.006), total scales (p=0.003) and Borg scale (p=0.011) all had statistical significance. CONCLUSIONS: Our questionnaire for assessing physical workloads demonstrated statistically significant reliability and validity. But the questions for the proportions of the workday with sitting work posture and with static posture should be modified via a larger study.
Automobiles ; Energy Metabolism ; Hand ; Heart Rate ; Motor Activity ; Posture ; Questionnaires* ; Reproducibility of Results* ; Shoulder ; Sweat ; Sweating ; Weights and Measures

BACKGROUND: The Kirschner wire (K-wire) technique allows stable fixation of bone fragments without periosteal dissection, which often lead to bone segment scattering and loss. The authors used the K-wire fixation to simplify the treatment of laborious comminuted zygomatic bone fracture and report outcomes following the operation. METHODS: A single-institution retrospective review was performed for all patients with comminuted zygomatic bone fractures between January 2010 and December 2013. In each patient, the zygoma was reduced and fixed with K-wire, which was drilled from the cheek bone and into the contralateral nasal cavity. For severely displaced fractures, the zygomaticofrontal suture was first fixated with a microplate and the K-wire was used to increase the stability of fixation. Each wire was removed approximately 4 weeks after surgery. Surgical outcomes were evaluated for malar eminence, cheek symmetry, Kwire site scar, and complications (based on a 4-point scale from 0 to 3, where 0 point is 'poor' and 3 points is 'excellent'). RESULTS: The review identified 25 patients meeting inclusion criteria (21 men and 4 women). The mean age was 52 years (range, 15-73 years). The mean follow up duration was 6.2 months. The mean operation time was 21 minutes for K-wire alone (n=7) and 52 minutes for K-wire and plate fixation (n=18). Patients who had received K-wire only fixation had severe underlying diseases or accompanying injuries. The mean postoperative evaluation scores were 2.8 for malar contour and 2.7 for K-wire site scars. The mean patient satisfaction was 2.7. There was one case of inflammation due to the K-wire. CONCLUSION: The use of K-wire technique was associated with high patient satisfaction in our review. K-wire fixation technique is useful in patient who require reduction of zygomatic bone fractures in a short operating time.
Bone Wires ; Cheek ; Cicatrix ; Follow-Up Studies ; Fractures, Bone ; Humans ; Inflammation ; Male ; Nasal Cavity ; Patient Satisfaction ; Retrospective Studies ; Sutures ; Zygoma ; Zygomatic Fractures*

PURPOSE: Postoperative pain for robotic thyroid surgeries including bilateral axillo-breast approach (BABA) has not been well studied. In this study, we have developed a self-reporting application (SRA) for iPad and prospectively collected pain scores from open thyroidectomy (OT) and BABA robotic thyroidectomy (RT) patients. METHODS: Female patients who underwent total thyroidectomy for papillary thyroid carcinoma were included. Patients recorded pain scores for throat, anterior neck, posterior neck, chest, and back on postoperative days 1, 2, and 3. Once discharged, on postoperative day 14, a survey was also conducted on satisfaction of SRA and cosmesis. RESULTS: A total of 54 patients were enrolled (27 BABA RT and 27 OT). There were no significant differences between the 2 groups in clinicopathological characteristics and postoperative complication rates. Postoperative pain scores at days 1, 2, 3, and 14 were not significantly different between the groups for throat, anterior neck, posterior neck, or back. Postoperative analgesic requirements were similar between the 2 groups. Wound satisfaction scores were significantly higher in the BABA RT group (BABA RT 7.4 vs. OT 5.7; P = 0.016). Satisfaction scores for the usefulness of SRA were above 7.2 for all four questionnaire items on the 10-point scale. CONCLUSION: Postoperative pain for BABA RT is equivalent to OT but offers greater cosmetic satisfaction for patients. A mobile device application such as SRA may facilitate proper assessment and management of pain in postoperative patients.
Female ; Humans ; Neck ; Pain, Postoperative* ; Pharynx ; Postoperative Complications ; Prospective Studies ; Thorax ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Wounds and Injuries

OBJECTIVE: Workload is known to affect the hypothalamus-pituitary-adrenal axis. Although many studies had revealed that job stress related factors could affect the neuroendocrine system among blue-collar workers, these studies had limitations as they had not evaluated the workload by objective methods which took into consideration individual physiological differences. This study was conducted to evaluate the effects of physical workload adjusted job stress on cortisol regulation by using objective tools for workers having various job tasks. METHODS: Among 110 foundry workers, shipyard workers, and fine machine assemblers for whom saliva samples were obtained, 102 without any past history of conditions that could affect hormonal regulation such as diabetes, and hypertension were included in this study. Among the 102 study participants, 15 workers whose saliva for morning or afternoon or heart rate monitoring data was not attained were excluded from the final analysis. Workload was evaluated by RHR (relative heart rate) using a heart rate monitor, and job stress was evaluated by Karasek's Job Content Questionnaire. Saliva samples were gathered during 8 - 9 am and 5 - 6 pm, and salivary cortisol levels were analysed by radioimmunoassay. RESULTS: After adjusting several variables which could effect cortisol secretion including job stress, among the higher RHR group morning salivary cortisol level was increased (beta=60.32, S.E.=26.35, p=0.0266), afternoon salivary cortisol level was decreased (beta=-7.43, S.E.=29.73, p=0.8044), and salivary cortisol level difference between morning and afternoon was increased (beta=72.10, SE=35.50, p=0.0509). CONCLUSIONS: As physical workload increases morning cortisol level, which is caused by the effect of arousal, and decreases afternoon cortisol level, which is caused by exhaustion, physical workload enlarges the width of diurnal cortisol variance. Therefore, physical exhaustion due to excessive workload could have adverse effects on the neuroendocrine system.
Arousal ; Axis ; Heart ; Heart Rate ; Hydrocortisone* ; Hypertension ; Neurosecretory Systems ; Questionnaires ; Radioimmunoassay ; Saliva

Typhoid fever, a serious systemic infection caused by Salmonella enterica serovar Typhi, breaks out in developing countries. However, existing vaccines only induce relatively low protective effects with humoral responses and do not stimulate secondary immune response, especially to young people. The objective of this study is to evaluate the immunogenicity of the vaccine containing virulence capsular polysaccharide (Vi) conjugated with the optimal ratios of non-toxic variant of diphtheria toxin (CRM(197)) in mice. Six-week-old BALB/c female mice were injected intraperitoneally three times at intervals of 14 days and sera were collected on days 0, 14, 28, 42 and 56 post-injection. The efficacy of the vaccine was evaluated by comparing between negative control group injected with PBS and vaccine groups injected with Vi or Vi-CRM(197) conjugate of different ratio. Vi and CRM(197)-specific antibody responses were evaluated using enzyme-linked immunosorbent assay. The result showed that Vi-CRM(197)-1 group revealed the highest and significant Vi-specific IgG immune responses among the other groups and Vi group (p < 0.01). In conclusion, Vi-CRM(197)-1 conjugate vaccine induced the highest humoral immune response in mice and may be used as an effective vaccine to replace the existing typhoid vaccine for infants under 2 years old.
Animals ; Antibody Formation ; Child, Preschool ; Developing Countries ; Diphtheria Toxin ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunity, Humoral ; Immunoglobulin G ; Infant ; Mice* ; Salmonella enterica* ; Salmonella typhi* ; Salmonella* ; Typhoid Fever ; Typhoid-Paratyphoid Vaccines ; Vaccines ; Virulence

Ion channels in carcinoma and their roles in cell proliferation are drawing attention. Intracellular Ca2+ ([Ca2+]i)-dependent signaling affects the fate of cancer cells. Here we investigate the role of Ca(2+)-activated K+ channel (SK4) in head and neck squamous cell carcinoma cells (HNSCCs) of different cell lines; SNU-1076, OSC-19 and HN5. Treatment with 1 microM ionomycin induced cell death in all the three cell lines. Whole-cell patch clamp study suggested common expressions of Ca(2+)-activated Cl- channels (Ano-1) and Ca(2+)-activated nonselective cation channels (CAN). 1-EBIO, an activator of SK4, induced outward K+ current (ISK4) in SNU-1076 and OSC-19. In HN5, ISK4 was not observed or negligible. The 1-EBIO-induced current was abolished by TRAM-34, a selective SK4 blocker. Interestingly, the ionomycin-induced cell death was effectively prevented by 1-EBIO in SNU-1076 and OSC-19, and the rescue effect was annihilated by combined TRAM-34. Consistent with the lower level of ISK4, the rescue by 1-EBIO was least effective in HN5. The results newly demonstrate the role of SK4 in the fate of HNSCCs under the Ca2+ overloaded condition. Pharmacological modulation of SK4 might provide an intriguing novel tool for the anti-cancer strategy in HNSCC.
Carcinoma, Squamous Cell* ; Cell Death* ; Cell Line ; Cell Proliferation ; Head* ; Ion Channels ; Ionomycin ; Neck* ; Neoplasms, Squamous Cell