In the neurovascular unit, the neuronal and vascular systems communicate with each other. O2 and nutrients, reaching endothelial cells (ECs) through the blood stream, spread into neighboring cells, such as neural stem cells, and neurons. The proper function of neural circuits in adults requires sufficient O2 and glucose for their metabolic demands through angiogenesis. In a central nervous system (CNS) injury, such as glioma, Parkinson’s disease, and Alzheimer’s disease, damaged ECs can contribute to tissue hypoxia and to the consequent disruption of neuronal functions and accelerated neurodegeneration. This review discusses the current evidence regarding the contribution of oxygen deprivation to CNS injury, with an emphasis on hypoxia-inducible factor (HIF)-mediated pathways and Notch signaling. Additionally, it focuses on adult neurological functions and angiogenesis, as well as pathological conditions in the CNS. Furthermore, the functional interplay between HIFs and Notch is demonstrated in pathophysiological conditions.

Objective: Financial hardship influences depression risk, however, the pathway of the effect of financial hardship on depression and the role of self-esteem remain unclear. This study examined whether changes in financial hardship affected depression, and whether self-esteem mediated by this relationship. Methods: Data from 99,588 observations of 15,331 individuals were extracted from 10 waves of the Korean Welfare Panel Study. The association between changes in financial hardship and depression was investigated using a generalized estimation equation, and the extent to which these associations were mediated by self-esteem was assessed. Results: The results indicated that changes in financial hardship were associated with depression, with varying magnitude. Experiencing severe financial hardship over two consecutive years (odds ratio [OR]: 3.87, 95% confidence interval [CI]=3.09–4.85) or increased financial hardship over the previous year strongly influenced depression (e.g., OR: 3.88, 95% CI=3.09–4.86 for low financial hardship at t-1 year and high at t year). Self-esteem plays a mediating role in the relationship between changes in financial hardship and depression, where persistent financial hardship is associated with low self-esteem, leading to depression. Conclusion These findings highlighted the importance of monitoring and intervention for financial hardship and psychological problems to help manage depression.

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

Background: Dentists make various efforts to reduce patients' anxiety and fear associated with dental treatment. Dental sedation is an advanced method that dentists can perform to reduce patients' anxiety and fear and provide effective dental treatment. However, dental sedation is different from general dental treatment and requires separate learning, and if done incorrectly, can lead to serious complications. Therefore, sedation is performed by a limited number of dentists who have received specific training. This study aimed to investigate the proportion of dentists who practice sedation and the main sedatives they use in the context of the Republic of Korea. Methods: We used the customized health information data provided by the Korean National Health Insurance. We investigated the number of dental hospitals or clinics that claimed insurance for eight main sedatives commonly used in dental sedation from January, 2007 to September, 2019 at the Health Insurance Review and Assessment Service. We also identified the changes in the number of dental medical institutions by region and year and analyzed the number and proportion of dental medical institutions prescribing each sedative. Results: In 2007, 302 dental hospitals prescribed sedatives, and the number increased to 613 in 2019. In 2007, approximately 2.18% of the total 13,796 dental institutions prescribed sedatives, increasing to 3.31% in 2019. In 2007, 168 institutions (55.6%) prescribed N2O alone, and in 2019, 510 institutions (83.1%) made claims for it. In 2007, 76 (25.1%) hospitals made claims for chloral hydrate, but the number gradually decreased, with only 29 hospitals (4.7%) prescribing it in 2019. Hospitals that prescribed a combination of N2O, chloral hydrate, and hydroxyzine increased from 27 (8.9%) in 2007 to 51 (9%) in 2017 but decreased to 38 (6.1%) in 2019. The use of a combination of N2O and midazolam increased from 20 hospitals (6.6%) in 2007 to 51 hospitals (8.3%) in 2019. Conclusion While there is a critical limitation to the investigation of dental hospitals performing sedation using insurance claims data, namely exclusion of dental clinics providing non-insured treatments, we found that in 2019, approximately 3.31% of the dental clinics were practicing sedation and that N2O was the most commonly prescribed sedative.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the impact of multi-tasking exercise on cognitive and motor function in patients with mild cognitive impairment (MCI) and cognitive normal elderly (CNE).METHODS: A total of 144 subjects were recruited from 14 regional dementia centers in Busan Metropolitan City. With the exception of 77 subjects unsuitable for the study, 67 subjects participated in the intervention. The Korean version of Mini-Mental State Examination for Dementia Screening (MMSE-DS), Subject Memory Complain Questionnaire (SMCQ), and the Korean version of the Short-Form Geriatric Depression Scale (SGDS-K) were used to determine changes in cognitive function and depressive symptoms pre-post intervention in patients with MCI and CNE, respectively. To observe changes in motor function, 5-chair sit to stand and 5-meter walking speed on the lower body strength and walking ability were also measured in both groups.RESULTS: For the MCI group, changes in cognitive and depressive symptoms on the tasks of MMSE-DS (p=0.006), SMCQ (p=0.000), SGDS-K (p=0.000) and the result of the motor function analysis on the items of 5-chair sit to stand (p=0.000), normal speed (p=0.004) and maximal speed (p=0.002) of 5-meter walking speed (p< 0.005). In the CNE group, all the items except MMSE-DS (p=0.068) and SGDS-K (p=0.095) showed statistically significant improvement.CONCLUSIONS: Multi-tasking exercise intervention, including exercise and cognitive tasks, may possibly improve the cognitive and motor function in patients with MCI and CNE.
Aged ; Busan ; Cognition Disorders ; Cognition ; Dementia ; Depression ; Humans ; Mass Screening ; Memory ; Mild Cognitive Impairment ; Walking

The purpose of this review is to examine the clinical use of functional near-infrared spectroscopy (fNIRS) in children and adolescents with psychiatric disorders. Many studies have been conducted using objective evaluation tools for psychiatric evaluation, such as predicting psychiatric symptoms and treatment responses. Compared to other tools, fNIRS has the advantage of being a noninvasive, inexpensive, and portable method and can be used with patients in the awake state. This study mainly focused on its use in patients with attention-deficit/hyperactivity disorder and autism spectrum disorder. We hope that research involving fNIRS will be actively conducted in various diseases in the future.

The purpose of this review is to examine the clinical use of functional near-infrared spectroscopy (fNIRS) in children and adolescents with psychiatric disorders. Many studies have been conducted using objective evaluation tools for psychiatric evaluation, such as predicting psychiatric symptoms and treatment responses. Compared to other tools, fNIRS has the advantage of being a noninvasive, inexpensive, and portable method and can be used with patients in the awake state. This study mainly focused on its use in patients with attention-deficit/hyperactivity disorder and autism spectrum disorder. We hope that research involving fNIRS will be actively conducted in various diseases in the future.

Background and Objectives: Some individuals exhibit discrepancies between risk classifications assessed using clinical factors and those obtained by vascular imaging. We aimed to evaluate whether statins provide clinical outcome benefits in patients classified as having low to moderate cardiovascular risk but with carotid plaque. Methods: This was a retrospective propensity score matching study. A total of 12,158 consecutive patients undergoing carotid ultrasound between January 2012 to February 2020 were screened. Individuals with low to moderate cardiovascular risk who were not currently recommended for statin therapy but had carotid plaques were included. Among 1,611 enrolled individuals, 806 (statin group: 403, control group: 403) were analyzed. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs: cardiovascular death, myocardial infarction, coronary revascularization, and ischemic stroke or transient ischemic attack) and all-cause mortality. Results: During the median follow-up of 6.0 years, the incidence of MACCEs did not differ between the groups (6.1 and 5.7/1,000 person-years in the control and statin groups, respectively; adjusted hazard ratio [HR], 0.95; p=0.90). The incidence of all-cause mortality did not differ (3.9 and 3.9/1,000 person-years, respectively; adjusted HR, 1.02; p=0.97). Kaplan-Meier curves revealed similar rates of MACCEs (log-rank p=0.72) and all-cause mortality (log-rank p=0.99) in the 2 groups. Age and smoking were independent predictors of MACCEs. Subgroups exhibited no differences in clinical outcomes with statin use. Conclusions Benefit of statin therapy was likely to be limited in low to moderate risk patients with carotid plaques. These results could guide physicians in clinical decision-making regarding cardiovascular prevention.

Background: The health system's capacity to store vaccines in North Korea has been less studied. In this study, we aimed to investigate if the current vaccine cold chain in North Korea can store routine vaccines and if it has the storage capacity to handle pandemic vaccination activities (PVAs) without interrupting the country’s successful routine immunization program. Methods: We used tables extracted from an evaluation report of The Global Alliance for Vaccines and Immunization (GAVI)’ Health Systems Strengthening program in North Korea from 2007 to 2014. We then used the World Health Organization’s Immunization Supply Chain Sizing Tool to estimate gaps and the cost of scaling up cold chain storage. Results: We found that the vaccine cold chain in North Korea has adequate storage capacity for routine vaccines. While we found a deficit of 7,172 L at the central medical warehouse (CMW) and 14,256 L at the provincial medical warehouses (PMWs), the storage at the county warehouses (CoMW) had a surplus. When assessed for PVA, we found an aggregated deficit of 115,574 L (CMW), 113,160 L (PMW), and 25,133 L (CoMW). To fill the gaps, investments of 229,917 USD, and 2,262,211 USD were estimated for routine and PVA vaccination programs, respectively. Conclusion As countries and the international community work to improve systems in preparation for future pandemics, there is a need to scale up the North Korean vaccine cold chain to a pandemic-ready state.

Background: The health system's capacity to store vaccines in North Korea has been less studied. In this study, we aimed to investigate if the current vaccine cold chain in North Korea can store routine vaccines and if it has the storage capacity to handle pandemic vaccination activities (PVAs) without interrupting the country’s successful routine immunization program. Methods: We used tables extracted from an evaluation report of The Global Alliance for Vaccines and Immunization (GAVI)’ Health Systems Strengthening program in North Korea from 2007 to 2014. We then used the World Health Organization’s Immunization Supply Chain Sizing Tool to estimate gaps and the cost of scaling up cold chain storage. Results: We found that the vaccine cold chain in North Korea has adequate storage capacity for routine vaccines. While we found a deficit of 7,172 L at the central medical warehouse (CMW) and 14,256 L at the provincial medical warehouses (PMWs), the storage at the county warehouses (CoMW) had a surplus. When assessed for PVA, we found an aggregated deficit of 115,574 L (CMW), 113,160 L (PMW), and 25,133 L (CoMW). To fill the gaps, investments of 229,917 USD, and 2,262,211 USD were estimated for routine and PVA vaccination programs, respectively. Conclusion As countries and the international community work to improve systems in preparation for future pandemics, there is a need to scale up the North Korean vaccine cold chain to a pandemic-ready state.