Coxsackievirus A16 (CA16), which primarily causes hand, foot, and mouth disease (HFMD), is associated with complications, such as encephalitis, acute flaccid paralysis, myocarditis, pericarditis, and shock. However, no case of pancreatitis associated with CA16 has been reported in children. We report a case of CA16-associated acute pancreatitis in a 3-year-old girl with HFMD. She was admitted because of poor oral intake and high fever for 1 day. Maculopapular rashes on both hands and feet and multiple vesicles on the soft palate were observed on physical examination. She was treated conservatively with intravenous fluids. On the fourth hospital day, she had severe abdominal pain and vomiting. The serum levels of amylase and lipase were remarkably elevated (amylase, 1,902 IU/L; reference range, 28–100 IU/L; lipase, >1,500 IU/L; reference range, 13–60 IU/L), and ultrasonography showed diffuse swelling of the pancreas with a small amount of ascites. The real-time reverse transcription polymerase chain reaction result from a stool sample was positive for CA16. CA16 can cause acute pancreatitis, and should be considered in the differential diagnosis of abdominal pain in children with HFMD.
Abdominal Pain ; Amylases ; Animals ; Ascites ; Child ; Child, Preschool ; Diagnosis, Differential ; Encephalitis ; Exanthema ; Female ; Fever ; Foot ; Foot-and-Mouth Disease ; Hand* ; Hand, Foot and Mouth Disease* ; Humans ; Lipase ; Mouth Diseases ; Myocarditis ; Palate, Soft ; Pancreas ; Pancreatitis* ; Paralysis ; Pericarditis ; Physical Examination ; Polymerase Chain Reaction ; Reference Values ; Reverse Transcription ; Shock ; Ultrasonography ; Vomiting

PURPOSE: To assess the accuracy of pachymetric measurement using Orbscan(Bausch and Lomb, USA) after laser in situ keratomileusis(LASIK), photorefractive keratectomy(PRK), and laser epithelial keratomileusis (LASEK). METHODS: Central corneal thickness of 159 nonoperated normal eyes, 55 eyes after LASIK, 12 after PRK, and 17 after LASEK was measured using ultrasound and Orbscan II. The acoustic factor (AF) was adjusted, based on the results obtained in the normal eye group, to minimize the difference between ultrasound and Orbscan pachymetric values. RESULTS: Using the adjusted AF (0.9607), the mean difference between Ultrasonic pachymetric and Orbscan measurement was 0.00 +/- 21.08, 20.44 +/- 24.12, 27.63 +/- 36.87, and 0.56 +/- 17.26 micro meter in the normal, LASIK, PRK, and LASEK groups, respectively. In the LASIK and PRK groups, there was a statistically significant difference between the two methods (both P<0.001). The postoperative ultrasound measurements were consistent with the theoretical residual corneal thickness in the LASIK and PRK groups (-2.96 +/- 18.00 micro meter, -1.00 +/- 13.59 micro meter), while Orbscan measurements were statistically significantly less than the theoretical residual corneal thickness in the LASIK and PRK groups (21.84 +/- 31.06 micro meter, p<0.001; 21.88 +/- 35.91 micro meter, P=0.036). CONCLUSIONS: Orbscan pachymetric values may be underestimated and less accurate after excimer refractive surgery, especially after LASIK and PRK.
Acoustics ; Keratectomy, Subepithelial, Laser-Assisted ; Keratomileusis, Laser In Situ ; Refractive Surgical Procedures* ; Ultrasonics ; Ultrasonography

BACKGROUND: Diabetes education, also known as diabetes self-management training or diabetes selfmanagement education, is effective in helping patients with diabetes control their illness and maximize their health. However, there is no established institutional strategy in South Korea because economic evaluations of the benefits and costs of diabetes education have been limited. The purpose of this study is two-fold: (1) describe economic evaluation methodologies, one of the tools available to help choose wisely from a range of alternatives and implement effective resources; and (2) suggest applications of economic evaluation in terms of diabetes education. METHODS: There are three types of commonly used economic evaluations in diabetes education: cost benefit analysis, cost effective analysis, and cost utility analysis. RESULTS: The understanding of the economic value of diabetes education for people with diabetes has a number of uses: to provide empirical evidence to influence policy-making in diabetes education, to offer proof of the benefits of diabetes self-management, to improve awareness of the importance and necessity of diabetes education, to reduce costs of diabetes management, and to enhance healthcare quality. CONCLUSION: Further research is needed to evaluate the economic benefits and costs associated with diabetes education.
Cost-Benefit Analysis ; Education* ; Evaluation Studies as Topic ; Humans ; Korea ; Quality of Health Care ; Self Care

It has been shown that the extracts including eupatilin and quercetin-3-beta-D-glucuronopyranoside had mucoprotective effects on the esophagus and stomach through their antioxidant activities. This study was designed to investigate the anti-inflammatory effect of these flavonoid compounds in an animal model of inflammatory bowel disease induced by 2,4,6-trinitrobenzene sulfonic acid. Experimental colitis was induced by intracolonic administration of 2,4,6-trinitrobenzene sulfonic acid. Extracts including eupatilin or quercetin-3-beta-D-glucuronopyranoside were orally administered to animals 48, 24, and 1 h prior to the induction of colitis and then again 24 h later. The animals were sacrificed 48 h after by 2,4,6-trinitrobenzene sulfonic acid treatment and the macroscopic appearance of the colonic lesions was scored in a blinded manner on a scale of 1 to 10. The inflammatory response to colitis induction was assessed by measuring myeloperoxidase activity, nitric oxide production, tumor necrosis factor-alpha expression, total glutathione levels, and malondialdehyde concentrations in the colon. The results indicated that extracts including eupatilin and extracts including quercetin-3-beta-D-glucuronopyranoside dose-dependently improved the morphology of the lesions induced by 2,4,6-trinitrobenzene sulfonic acid and reduced the ulcer index accordingly. In addition, rats receiving extracts including eupatilin and extracts including quercetin-3-beta-D-glucuronopyranoside showed significantly decreased levels of mucosal myeloperoxidase activity, nitric oxide production, tumor necrosis factor-alpha expression, and malondialdehyde levels, and increased total glutathione levels. Extracts including eupatilin and extracts including quercetin-3-beta-D-glucuronopyranoside ameliorated the inflammatory response and colonic injury in acute colitis by decreasing oxidative stress and neutrophil activation. Extracts including eupatilin and extracts including quercetin-3-beta-D-glucuronopyranoside may inhibit acute colitis.
Animals ; Colitis* ; Colon ; Esophagus ; Flavonoids* ; Glutathione ; Inflammation ; Inflammatory Bowel Diseases ; Malondialdehyde ; Models, Animal ; Neutrophil Activation ; Nitric Oxide ; Oxidative Stress ; Peroxidase ; Quercetin ; Rats* ; Reactive Oxygen Species ; Stomach ; Tumor Necrosis Factor-alpha ; Ulcer

Pruritus (itching) is classically defined as an unpleasant cutaneous sensation that leads to scratching behavior. Although the scientific criteria of classification for pruritic diseases are not clear, it can be divided as acute or chronic by duration of symptoms. In this study, we investigated whether skin injury caused by chemical (contact hypersensitivity, CHS) or physical (skin-scratching stimulation, SSS) stimuli causes initial pruritus and analyzed gene expression profiles systemically to determine how changes in skin gene expression in the affected area are related to itching. In both CHS and SSS, we ranked the Gene Ontology Biological Process terms that are generally associated with changes. The factors associated with upregulation were keratinization, inflammatory response and neutrophil chemotaxis. The Kyoto Encyclopedia of Genes and Genomes pathway shows the difference of immune system, cell growth and death, signaling molecules and interactions, and signal transduction pathways. Il1a , Il1b and Il22 were upregulated in the CHS, and Tnf, Tnfrsf1b, Il1b, Il1r1 and Il6 were upregulated in the SSS. Trpc1 channel genes were observed in representative itching-related candidate genes. By comparing and analyzing RNA-sequencing data obtained from the skin tissue of each animal model in these characteristic stages, it is possible to find useful diagnostic markers for the treatment of itching, to diagnose itching causes and to apply customized treatment.
Animals ; Biological Processes ; Chemotaxis ; Classification ; Cytokines ; Dermatitis, Contact* ; Gene Expression ; Gene Ontology ; Genome ; Hypersensitivity ; Immune System ; Interleukin-6 ; Mice* ; Models, Animal ; Neutrophils ; Pruritus* ; RNA* ; Sensation ; Sequence Analysis, RNA* ; Signal Transduction ; Skin* ; Transcriptome ; Transient Receptor Potential Channels ; Up-Regulation ; Wound Healing

Objective: Suicide is a huge nationwide problem that incurs a lot of socio-economic costs. Suicide also inflicts severe distress on the people left behind. The government of the Republic of Korea has been making many policy efforts to reduce suicide rate. The gatekeeper program, ‘Suicide CARE’, is one of the meaningful modalities for preventing suicide. Methods: Multidisciplinary research team collaborated to update the ‘Suicide CARE’ to version 2.0. Results: In the ‘Introductory part’, the authors have the time to think about the necessity and significance of the program before conducting full-scale gatekeeper training. In the ‘Careful observation’ part, trainees learn how to understand and recognize the various linguistic, behavioral, and situational signals that a person shows before committing suicide. In the ‘Active listening’ part, trainees learn how to ask suicide with a value-neutral attitude as well listening empathetically. In the ‘Risk evaluation and Expert referral’ part, trainees learn intervening strategies to identify a person’s suicidal intention, plan, and past suicide attempts, and connect the person to appropriate institutes or services. Conclusion Subsequent studies should be conducted to verify the efficacy of the gatekeeper program.

Objective: In 2011, “Suicide CARE” (Standardized Suicide Prevention Program for Gatekeeper Intervention in Korea) was originally developed for the early detection of warning signs of suicide completion, since there is a tendency to regard emotional suppression as a virtue of Korean traditional culture. A total of 1.2 million individuals completed the training program of “Suicide CARE” in Korea. Methods: More sophisticated suicide prevention approaches according to age, sex, and occupation have been proposed, demanding for a more detailed revision of “Suicide CARE.” Thus, during the period from August 2019 to February 2020, “Suicide CARE” has been updated to version 2.0. The assessments on domestic gatekeeper training programs for suicide prevention, international gatekeeper training programs for suicide prevention, psychological autopsy interview reports between 2015 and 2018, and the evaluation of feedback from people who completed “Suicide CARE” version 1.6 training were performed. Results: We describe the revision process of “Suicide CARE,” revealing that “Suicide CARE” version 2.0 has been developed using an evidence-based methodology. Conclusion It is expected that “Suicide CARE” version 2.0 be positioned as the basic framework for many developing gatekeeper training programs for suicide prevention in Korea in the near future.