This study aimed to analyze trends in research on depression among medical students in Korea and to conduct a meta-analysis to determine the average correlation coefficients between depression and related variables. In total, 38 quantitative studies (four theses and 34 journal articles) published between January 1995 and February 2023 were analyzed according to publication year, subjects, analysis methods, and measurement tools. Among them, 15 studies that provided numerical information on the relationships between depression and variables such as self-esteem, social support, grade point average (GPA), stress, and academic stress were selected for meta-analysis. The main findings of this study were as follows. First, quantitative research on depression among medical students began in earnest in 2009, and cross-sectional studies targeting first-year and second-year medical students were the most prevalent. Furthermore, the most commonly used analysis method was difference testing, and the Beck Depression Inventory was the most frequently used measurement tool. Second, the mean correlation coefficients between depression and stress, self-esteem, social support, academic stress, and GPA were 0.534, 0.532, 0.465, 0.390, and 0.102, respectively. The results for self-esteem, stress, and academic stress showed substantial heterogeneity, while those for social support and GPA showed little heterogeneity. These findings suggest that educational interventions, such as social support improvement programs, are necessary to prevent depression among medical students.

Secondary amyloidosis occurs in patients with chronic inflammatory diseases, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). The major therapeutic approach to secondary amyloidosis involves controlling the underlying inflammatory disease. Tumor necrosis factor-alpha (TNF-alpha) inhibitors have revolutionized the treatment of rheumatic diseases; in many cases dramatic clinical improvement of secondary amyloidosis due to AS has been observed in response to treatment with these agents. However, the development of secondary amyloidosis associated with AS refractory to treatment with TNF-alpha inhibitors has been infrequently reported. Here, we described a case of a 37-year-old male patient with longstanding AS who was diagnosed with secondary amyloidosis due to high disease activity despite treatment with etanercept, adalimumab and infliximab.
Adult ; Amyloidosis* ; Arthritis, Rheumatoid ; Humans ; Male ; Rheumatic Diseases ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha* ; Adalimumab ; Infliximab ; Etanercept

OBJECTIVE: To investigate the synovial mRNA expression of receptor activator of NFkappaB (RANK), RANK ligand (RANKL), osteoprotegerin (OPG) and RANKL/OPG mRNA expression ratio, and to evaluate the effects of IL-17 in experimental rheumatoid arthritis (RA) model. METHODS: After induction of collagen-induced arthritis (CIA) by type II collagen in DBA1 mice, mice were anesthetized at day 28 and a small aperture in the skin of the knee was performed. Mice, in which arthritis of knee was present, were selected and divided into 3 groups, and phosphate-buffered saline (PBS group), IL-17 (IL-17 group) or anti-IL-17 monoclonal antibody (anti-IL-17 group) was injected to both knee joint at day 28 and 32. At day 35, mice were sacrificed and synovium of knee joints were isolated. Synovial mRNA expression of RANKL, RANK and OPG was assessed by real-time RT-PCR and immunohistochemical stain. RESULTS: Synovial RANKL and RANK mRNA expressions were significantly different among IL-17, PBS, anti-IL-17 and normal group (IL-17>PBS>anti-IL-17>normal group), and synovial OPG mRNA expressions in PBS, IL-17 and anti-IL-17 group were significantly high than those in normal group, however, there was no significant difference among IL-17, PBS and anti-IL-17 group. RANKL/OPG mRNA ratio was significantly different among these groups (IL-17>PBS>anti-IL-17>normal group). In immunohistochemical stain, RANKL, RANK and OPG-positive cells were expressed at synovium. CONCLUSION: Synovial RANKL/OPG mRNA ratio was enhanced in CIA, and IL-17 induced higher RANKL/OPG ratio in the synovium of CIA, which was blocked by anti-IL-17 antibody. These results suggest that RANKL/OPG mRNA ratio play an important roles on bone destruction, and IL-17 may be actively involved in bone destruction by enhancing RANKL/OPG ratio in CIA model.
Animals ; Arthritis ; Arthritis, Experimental ; Arthritis, Rheumatoid* ; Collagen Type II ; Interleukin-17* ; Knee ; Knee Joint ; Mice ; Osteoprotegerin ; RANK Ligand ; RNA, Messenger* ; Skin ; Synovial Membrane

OBJECTIVES: To analyze differences in health behaviors among the social strata in Korea by using the 1995 National Health and Health Behavior Survey Data. METHODS: Study participants numbered 2,352 men and 1,016 women aged between 15-64 years old, with housewives, students and non-waged family workers excluded. Health behaviors in this study were defined according to the recommendations of the Alameda 7 study. The measure of health behaviors was based on the Health Practices Index(HPI; 0-5 range, with the exclusion of snacking between meals and regularly eating breakfast) developed by the Alameda County research. The significance of the relationship between social strata and HPI was assessed by considering the adjusted means from the multi-variate model. RESULTS: For men, incidence rates of never having smoked, no/moderate use of alcohol, regular exercise, and regular 7-8 hours sleep per night were higher in the upper social strata. Meanwhile, for women, incidence rates of never having smoked, no/moderate use of alcohol, appropriate weight, regular exercise, and regular 7-8 hours sleep per night were higher in the upper strata. HPI varied significantly among social strata in both sexes (p<0.001), a result which held true when adjusted for age, education, income, social insurance type, marital status and region. CONCLUSIONS: Health behaviors assessed by Health Practices Index(HPI) varied significantly among social strata for both sexes. Therefore, the existing gap in health behaviors among social strata can be corrected more effectively by target oriented health promotional activities.
Eating ; Education ; Female ; Health Behavior* ; Health Promotion ; Humans ; Incidence ; Korea* ; Male ; Marital Status ; Meals ; Smoke ; Snacks ; Social Security

Intermetatarsal coalition (IC) is very rare; although few cases have been reported in foreign orthopedic journals, these have not originated in our country. We report the case of a 20-year-old man who complained of pain in the left forefoot only during long distance running (3 km). On examination, his foot shape, skin appearance, and gait were normal, with no plantar keratosis; however, the radiograph revealed coalition between the fourth and fifth metatarsals. Surgical excision was performed. In the histopathologic study, fibrous coalition was confirmed. This paper reports an uncommon case involving surgical excision of IC in the military service, involving active sport activity.
Foot ; Gait ; Humans ; Keratosis ; Metatarsal Bones ; Military Personnel ; Orthopedics ; Running ; Skin ; Sports ; Synostosis ; Young Adult

BACKGROUND: Portable cardiopulmonary bypass (CPB) technique has been used increasingly as a potent and effective option for emergency cardiopulmonary resuscitation (CPR) because it can maintain more stable hemodynamics and provide better survival than conventional CPR techniques. This study was designed to develop a prototype of Korean portable CPB system and, by applying it to CPR, to discriminate whether it would be superior to standard open-chest CPR. MATERIAL AND METHOD: By using adult mongrel dogs, open-chest CPR (OCPR group, n=4) and portable-CPB CPR (CPB group, n=4) were compared with respects to restoration of spontaneous circulation (ROSC), hemodynamics, effects on blood cells, blood gas patterns, biochemical markers, and survivals. Ventricular fibrillation-cardiac arrest (VF-CA) of arrest (VF-CA) of 4 minutes followed by basic life support (BLS) of 15 minutes was applied in either group, which was standardized by the protocol of American Heart Association. Then, advanced life support (ALS) was applied to either group under the support of internal cardiac massage or CPB. ALS was maintained until ROSC was achieved but not longer than 30 minutes regardless of the presence of ROSC. All of the measured values were expressed as means+/-SD percent change from baseline. RESULT: During the early ALS, higher mean arterial pressure was maintained in CPB group than in OCPR group (90+/-19 vs. 71+/-32 %; p<.05) and lower mean pulmonary arterial pressure was also maintained in CPB group than in OCPR group (105+/-24 vs. 146+/-6%; p<.05). ROSC was achieved in all dogs. Post-ROSC levels of hematocrit, RBC, and platelet were decreased and plasma free hemoglobin was increased significantly in CPB group compared to OCPR group (p<.05). Changes in blood gas patterns, lactate, and CK-MB levels were not different between groups. Early mortality was seen in 3 dogs in OCPR group (survival time 31+/-36 hours) and 2 in CPB group (228+/-153 hours, p=ns). The remainders in both groups showed prolonged survival. CONCLUSION: These findings indicate that portable CPB can be effective to maintain stable hemodynamics during cardiac arrest, to achieve ROSC and to prolong survival. Further study is needed to refine the portable CPB system and to meet clinical challenges.
Adult ; American Heart Association ; Animals ; Arterial Pressure ; Biomarkers ; Blood Cells ; Blood Platelets ; Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation* ; Dogs* ; Emergencies* ; Heart Arrest* ; Heart Massage ; Hematocrit ; Hemodynamics ; Humans ; Lactic Acid ; Mortality ; Plasma

BACKGROUND/AIMS: Magnifying endoscopy with narrow band imaging (ME-NBI) is a useful modality for the detailed visualization of microsurface (MS) and microvascular (MV) structures in the gastrointestinal tract. This study aimed to determine whether the MS and MV patterns in ME-NBI differ according to the histologic type, invasion depth, and mucin phenotype of early gastric cancers (EGCs). METHODS: The MS and MV patterns of 160 lesions in 160 patients with EGC who underwent ME-NBI before endoscopic or surgical resection were prospectively collected and analyzed. EGCs were categorized as either differentiated or undifferentiated and as either mucosal or submucosal, and their mucin phenotypes were determined via immunohistochemistry of the tumor specimens. RESULTS: Differentiated tumors mainly displayed an oval and/or tubular MS pattern and a fine network or loop MV pattern, whereas undifferentiated tumors mainly displayed an absent MS pattern and a corkscrew MV pattern. The destructive MS pattern was associated with submucosal invasion, and this association was more prominent in the differentiated tumors than in the undifferentiated tumors. MUC5AC expression was increased in lesions with either a papillary or absent MS pattern and a corkscrew MV pattern, whereas MUC6 expression was increased in lesions with a papillary MS pattern and a loop MV pattern. CD10 expression was more frequent in lesions with a fine network MV pattern. CONCLUSIONS: ME-NBI can be useful for predicting the histopathology and mucin phenotype of EGCs.
Endoscopy* ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Mucins* ; Narrow Band Imaging* ; Phenotype* ; Prospective Studies ; Stomach Neoplasms*

BACKGROUND: This study evaluated the effects of remifentanil on hemodynamic changes in endotracheal intubation during rapid sequence induction using thiopental or propofol and succinylcholine. METHODS: One hundred and twenty patients were divided into 4 groups (30 patients in each group).Anesthesia was induced with propofol 2 mg/kg or thiopental 5 mg/kg and succinylcholine 1 mg/kg followed by remifetanil 0.5microgram/kg (group PR), remifentanil 1microgram/kg (group TR) or normal saline as control (group PC, group TC).An endotracheal intubation was performed 90 s later, and vecuronium 0.08 mg/kg was given for neuromuscular block.Anesthesia was maintained using 1-3 vol% enflurane with 2 L/min N2O and 2 L/min O2.Arterial blood pressure (ABP) and heart rate (HR) were recorded before induction, just before intubation, and at 1 min intervals for 5 min after intubation.The incidence of hypertension, hypotension, tachycardia, and bradycardia were recorded. RESULTS: ABP in group PR was lower than in group TR, but HR was not different.The incidence of hypotension in group PR was higher than group TR or group PC.ABP in groups using remifentanil was lower than in control groups.The incidence of hypertension and tachycardia in groups using remifentanil were lower than control groups. CONCLUSIONS: During administration of propofol or thiopental and succinylcholine, remifentanil as a bolus for rapid sequence induction attenuated cardiovascular responses to endotracheal intubation effectively, but with a higher incidence of hypotension following propofol.
Blood Pressure ; Bradycardia ; Enflurane ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Incidence ; Intubation ; Intubation, Intratracheal ; Piperidines ; Propofol ; Succinylcholine ; Tachycardia ; Thiopental ; Vecuronium Bromide

BACKGROUND AND OBJECTIVES: Although the Tei index is a useful predictor of global ventricular function, it has not been investigated at the level of regional myocardial function. We therefore investigated the segmental tissue Doppler image derived-Tei index (TDI-Tei index) in patients with regional wall motion abnormalities. SUBJECTS AND METHODS: We prospectively studied 17 patients (mean age 62+/-9 years, 5 women) with left ventricular (LV) regional wall motion abnormalities. The Tei index, defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), was measured in the basal and mid segments of the LV walls from standard apical views (4-, 2-, and 5-chamber views). We also obtained TDI velocity data in each segment. LV wall motion was classified as normal, hypokinetic, or akinetic, based on visual analysis. The TDI-Tei index, peak systolic myocardial velocity (Sm), early diastolic myocardial velocity (Em), and late diastolic myocardial velocity (Am) were analyzed in a total of 203 segments. RESULTS: Mean LV ejection fraction was 41.8+/-8.5%. TDI-Tei indices of dysfunctional segments (akinesis or hypokinesis, n=63) were significantly higher than those of normal segments (n=140) (0.714+/-0.169 vs. 0.669+/-0.135, p=0.041, respectively). Average values of TDI-Tei index, Sm, Em, and Am were 0.742+/-0.201, 4.206+/-1.336, 5.258+/-1.867, and 5.578+/-2.354 in akinetic segments; 0.677+/-0.101, 4.908+/-1.615, 5.369+/-2.121, and 5.542+/-2.492 in hypokinetic segments; and 0.669+/-0.135, 5.409+/-1.519, 6.108+/-2.356, and 6.719+/-2.466 in normal segments, respectively. A significant negative correlation was apparent between the TDI-Tei index and Sm (r=-0.302, p<0.001). CONCLUSION: These data suggest that the value of the segmental TDI-Tei index differs significantly according to regional function grade.
Contracts ; Humans ; Myocardial Contraction ; Prospective Studies ; Relaxation ; Ventricular Function

Objective: To investigate the expression of toll-like receptor (TLR)-2, 4 and 9 in idiopathic inflammatory myopathies (IIMs). Methods: The expression of TLR-2, 4 and 9 was measured by real-time RT-PCR and immunohistochemical stain (IHS) from muscle tissues in patients with IIMs and controls. Results: The expression levels of TLR-2, 4 and 9 in IIMs were significantly higher than controls. TLR-2, 4 and 9 were mainly expressed on sarcolemma of muscle fibers, perimysial vascular endothelium and infiltrating inflammatory cells in dermatomyositis, whereas, they were mainly expressed on sarcolemma of muscle fibers, destructed muscle fibers, and enodmysial infiltrating inflammatory cells in polymyositis. Conclusion: TLR-2, 4 and 9 were highly expressed in muscle tissue of IIMs. These results suggest that TLR-2, 4 and 9 play a role in pathogenesis of IIMs.
Dermatomyositis ; Endothelium, Vascular ; Humans ; Myositis* ; Polymyositis ; Sarcolemma ; Toll-Like Receptors*