Japan has the highest proportion of older adults worldwide and has consistently strengthened its healthcare system to mitigate the medical and welfare burden associated with population aging. Primary care has been positioned as a key strategy for establishing a sustainable healthcare system within a super-aged society. Japan has pursued this goal through the implementation of community-based integrated care systems, the operation of a long-term care insurance system, the specialized training of primary care physicians, and the establishment of the “Comprehensive Medical Specialist” program. These initiatives aim to optimize the utilization of healthcare resources and ensure the long-term sustainability of the healthcare system. Japan’s experience offers critical insights for Korea, which requires effective strategies to strengthen its primary care system.

Japan has the highest proportion of older adults worldwide and has consistently strengthened its healthcare system to mitigate the medical and welfare burden associated with population aging. Primary care has been positioned as a key strategy for establishing a sustainable healthcare system within a super-aged society. Japan has pursued this goal through the implementation of community-based integrated care systems, the operation of a long-term care insurance system, the specialized training of primary care physicians, and the establishment of the “Comprehensive Medical Specialist” program. These initiatives aim to optimize the utilization of healthcare resources and ensure the long-term sustainability of the healthcare system. Japan’s experience offers critical insights for Korea, which requires effective strategies to strengthen its primary care system.

Japan has the highest proportion of older adults worldwide and has consistently strengthened its healthcare system to mitigate the medical and welfare burden associated with population aging. Primary care has been positioned as a key strategy for establishing a sustainable healthcare system within a super-aged society. Japan has pursued this goal through the implementation of community-based integrated care systems, the operation of a long-term care insurance system, the specialized training of primary care physicians, and the establishment of the “Comprehensive Medical Specialist” program. These initiatives aim to optimize the utilization of healthcare resources and ensure the long-term sustainability of the healthcare system. Japan’s experience offers critical insights for Korea, which requires effective strategies to strengthen its primary care system.

Japan has the highest proportion of older adults worldwide and has consistently strengthened its healthcare system to mitigate the medical and welfare burden associated with population aging. Primary care has been positioned as a key strategy for establishing a sustainable healthcare system within a super-aged society. Japan has pursued this goal through the implementation of community-based integrated care systems, the operation of a long-term care insurance system, the specialized training of primary care physicians, and the establishment of the “Comprehensive Medical Specialist” program. These initiatives aim to optimize the utilization of healthcare resources and ensure the long-term sustainability of the healthcare system. Japan’s experience offers critical insights for Korea, which requires effective strategies to strengthen its primary care system.

BACKGROUND: Although transfusion is a paramount life-saving therapy, there are multiple potential significant risks. Therefore, all adverse transfusion reaction (ATR) episodes require close monitoring. Using the computerized reporting system, we assessed the frequency and pattern of non-infectious ATRs. METHODS: We analyzed two-year transfusion data from electronic medical records retrospectively. From March 2013 to February 2015, 364,569 units of blood were transfused. Of them, 334,582 (91.8%) records were identified from electronic nursing records. For the confirmation of ATRs by blood bank physicians, patients' electronic medical records were further evaluated. RESULTS: According to the nursing records, the frequency of all possible transfusion-related events was 3.1%. After the blood bank physicians' review, the frequency was found to be 1.2%. The overall frequency of febrile non-hemolytic transfusion reactions (FNHTRs) to red blood cells (RBCs), platelet (PLT) components, and fresh frozen plasmas (FFPs) were 0.9%, 0.3%, and 0.2%, respectively, and allergic reactions represented 0.3% (RBCs), 0.9% (PLTs), and 0.9% (FFPs), respectively. The pre-storage leukocyte reduction significantly decreased the frequency of FNHTRs during the transfusion of RBCs (P<0.01) or PLTs (Pfalling dots0.01). CONCLUSIONS: The frequency of FNHTRs, allergic reactions, and "no reactions" were 22.0%, 17.0%, and 60.7%, respectively. Leukocyte-reduction was associated with a lower rate of FNHTRs, but not with that of allergic reactions. The development of an effective electronic reporting system of ATRs is important in quantifying transfusion-related adverse events. This type of reporting system can also accurately identify the underlying problems and risk factors to further the quality of transfusion care for patients.
Blood Transfusion/*adverse effects/statistics & numerical data ; Humans ; Republic of Korea/epidemiology ; Retrospective Studies ; Tertiary Care Centers ; Transfusion Reaction/*epidemiology/etiology

Anemia ; Antibodies ; Blood Transfusion ; Erythrocytes ; Female ; Humans ; Intellectual Disability ; Iron ; Isoantibodies ; Korea ; Mass Screening ; P Blood-Group System ; Phenotype ; Polymerase Chain Reaction ; Prevalence ; Rehabilitation ; Serologic Tests ; Young Adult

Antibodies to high-incidence red blood cell antigens should be considered if panagglutination reactions are noted in all panel cells, and negative reactions to autologous red blood cells are detected on antibody screening and identification tests. In Korea, most of those antibodies are identified through international reference laboratories. To prevent a hemolytic transfusion reaction, antigen-negative red cells should be provided for those patients who have antibodies to red cell antigens. However, this is nearly impossible when the antibody has specificity to high-incidence red cell antigen. In those cases, transfusion of autologous blood, cryopreserved rare blood and the least incompatible blood components can be considered. In the case of surgery, acute normovolemic hemodilution or intraoperative blood salvage can also be considered. For the patients who have antibodies to high-incidence red cell antigens, it should be discussed to set up a national reference laboratory to quickly identify antibody specificities, and to consider establishing rare blood donor registry and frozen rare blood storage/supply system. This article reviews characteristics of antibodies to high-incidence antigens found in Koreans and also the transfusion experiences of those patients based on literature.
Antibodies ; Antibody Specificity ; Blood Donors ; Erythrocytes ; Hemodilution ; Humans ; Isoantibodies ; Korea ; Mass Screening ; Operative Blood Salvage ; Sensitivity and Specificity ; Transfusion Reaction

BACKGROUND: Adverse transfusion reactions (ATRs) are clinically relevant to patients with significant morbidity and mortality. This study aimed to review the cases of ATR reported in the recipient-triggered trace back system for a recent nine-year period in Korea. METHODS: Nine-year data obtained from 2006 to 2014 by the trace back system at the Division of Human Blood Safety Surveillance of the Korean Centers for Disease Control (KCDC) were reviewed. The suspected cases were assessed according to six categories: (i) related to, (ii) probably related to, (iii) probably not related to, (iv) not related to transfusion, (v) unable to investigate, and (vi) under investigation. RESULTS: Since 2006, 199 suspected serious ATRs were reported in hospitals and medical institutions in Korea, and these ATRs were reassessed by the division of Human Blood Safety Surveillance of the KCDC. Among the reported 193 cases as transfusion related infections, hepatitis C virus (HCV) infection (135, 67.8%) was reported most frequently, followed by hepatitis B virus (HBV) infection (27, 13.6%), HIV infection (13, 6.5%), syphilis (9, 4.5%), malarial infection (4, 2.0%), other bacterial infections (3, 1.5%), HTLV infection (1, 0.5%), and scrub typhus infection (1, 0.5%), respectively. Of the 199 cases, 13 (6.5%) cases were confirmed as transfusion-related (3 HCV infections, 3 malarial infections, 1 HBV infection, 2 Staphylococcus aureus sepsis, 3 transfusion-related acute lung injuries, and 1 hemolytic transfusion reaction). CONCLUSIONS: This is the first nationwide data regarding serious ATRs in Korea and could contribute to the implementation of an effective hemovigilance system.
Acute Lung Injury/epidemiology/etiology ; Blood Transfusion/*adverse effects ; HIV Infections/epidemiology/etiology ; Hepatitis C/epidemiology/etiology ; Humans ; Malaria/epidemiology/etiology ; Republic of Korea ; Retrospective Studies ; Transfusion Reaction/*etiology

BACKGROUND: A protocol for using human endometrium derived induced pluripotent stem cells (iPSCs) to derive hematopoietic and erythroid lineages will be elaborated, through a two-phase culture system. METHODS: Discarded endometrial tissues were obtained from women receiving hysterectomy in their 4th to 5th decade due to benign uterine conditions. pCE-Sox2, Oct4, Klf4, L-Myc and Lin28 episomal vectors were used to electrotransfect the endometrial stromal cells. The first 8 days involves commitment to hematopoietic stem cells through embryoid body with robust expansion on murine bone marrow stromal cells. The second phase involves feeder free conditions with hydrocortisone, stem cell factor, interleukin-3, and recombinant EPO. After 22 days of feeder free culture, the expression profiles of CD235a+ , CD34+ , CD43+ and CD 71+ were analyzed by flow cytometry and Wright-Giemsa staining for differential counting. The oxygen carrying capacity of cultured RBCs was measured using a hemoxanalyser. RESULTS: As a result of inducing these cells via co-culture with murine stromal fibroblasts, all endometrium derived iPSCs were differentiated into erythroblasts with a stable yield of approximately 80% for polychromatic and orthochromatic normoblasts. The protocol for complete induction of erythroid lineage cells starting from human endometrial tissue via iPS cells has been optimized. CONCLUSION Successful directed erythroid differentiation has occurred from human endometrium-derived iPS cells. A comprehensive process of actually deriving iPS cells using discarded surgical hysterectomy specimens to the erythroid fate has significance in that the scope of using human iPSC cell lines for tissue regeneration could be expanded in the future.

Background: The Jr a antigen is a high-prevalence red blood cell (RBC) antigen. Reports on cases of fatal hemolytic disease of the fetus and newborn and acute hemolytic transfusion reactions suggest that antibodies against Jr a (anti-Jra ) have potential clinical significance.Identifying anti-Jra is challenging owing to a lack of commercially available antisera. We developed an alternative approach to rapidly predict the presence of anti-Jra using the TaqMan single-nucleotide polymorphism (SNP)-genotyping method. Methods: Residual peripheral blood samples from 10 patients suspected of having the anti-Jr a were collected. Two samples with confirmed Jr(a–) RBCs and anti-Jra were used to validate the TaqMan genotyping assay by comparing the genotyping results with direct sequencing. The accuracy of the assay in predicting the presence of anti-Jra was verified through crossmatching with in-house Jr(a–) O+ RBCs. Results: The TaqMan-genotyping method was validated with two Jr(a–) RBC- and anti-Jra -confirmed samples that showed concordant Jr a genotyping and direct sequencing results.Jra genotyping for the remaining samples and crossmatching the serum samples with inhouse Jr(a–) O+ RBCs showed consistent results. Conclusions We validated a rapid, simple, accurate, and cost-effective method for predicting the presence of anti-Jra using a TaqMan-based SNP-genotyping assay. Implementing this method in routine practice in clinical laboratories will assist in solving difficult problems regarding alloantibodies to high-prevalence RBC antigens and ultimately aid in providing safe and timely transfusions and proper patient care.