Purpose: Healthy aging is an important concern in an aging society. Although the causal relationship between hypogonadism and erectile dysfunction in elderly men remains unclear, many physicians have achieved positive results after implementing exogenous testosterone supplementation therapy in patients with normal or slightly low blood testosterone. The purpose of this study was to conduct a systematic review and meta-analysis on whether testosterone replacement therapy (TRT) could improve sexual function in the elderly, as reported recently. Materials and Methods: As a comprehensive literature search was performed to find articles published in PubMed, Embase, and Cochrane databases by January 2022. The search used keywords of ‘aged’, ‘male’, ‘sexual behavior’, and ‘testosterone’. Randomized controlled trials (RCTs) were finally selected. As the main effect variable, results of a questionnaire on sexual function were analyzed and the effects of TRT were compared to those of placebo control. Results: Five RCT studies were included in this meta-analysis. The overall improvement by mean difference of sexual function for testosterone supplementation was 0.082 (95% CI: -0.049 to 0.213). In subgroup analysis, only intramuscular injection of 1,000 mg testosterone significantly improved sexual function of the elderly (0.229, 95% CI: 0.112 to 0.347). There was no significant difference in sexual function according to testosterone dose in meta-ANOVA (p=0.957). The difference was not statistically significant either in the meta-regression test (p=0.310). Egger’s regression coefficient test did not indicate a publication bias (p=0.132). Conclusions Although our overall effect size (that is, sexual function effect of TRT) did not show a significant improvement, the direction of improvement in erection and motivation was clearly shown. The injection formulation resulted in a significant sexual function improvement. Since only a few RCTs were included in the analysis, more well-designed prospective studies are needed to have a definite conclusion.

Objective: Biliary decompression through bile drainage is a key treatment for common bile duct obstruction with cholangitis. However, the effectiveness of early interventions has not been studied sufficiently in Korea. This study investigated the effectiveness of fast-track biliary decompression. Methods: A group of patients diagnosed with common bile duct obstruction with cholangitis between January 1, 2014, and December 31, 2019, was reviewed retrospectively. We divided them into two groups: before and after the implementation of fast-track biliary decompression. The following items were analyzed in the two groups: time to intervention, number of hospital days, length of stay in the emergency department, and intensive care unit (ICU) admission. Results: Between January 1, 2014, and December 31, 2019, 418 patients were admitted for common bile duct obstruction, and a total of 369 patients were included in this study. Of these, 168 patients visited the hospital prior to implementation of the treatment, and 201 patients visited after implementation. The time to intervention was 6.1 (4.2-11.0) hours in the fast-track group, which was about 9 hours shorter than the other group (P<0.001). There was no statistical difference in the number of hospital days, emergency department length of stay, and ICU admissions (P=0.535, P=0.034, P=0.322). Conclusion The time to intervention was shortened significantly in the fast-track group. However, we did not observe a significant improvement in patient prognosis. It may be possible that the procedure time may need to be shortened for a better prognosis. This should be investigated in future studies.

Purpose: Trocar-site burns occurring during laparoscopic surgery have been reported in various cases, and several efforts to reduce them are underway. This study aimed to analyze the effect of capacitive coupling on trocar site by observing electrical and histological changes for electrical skin burn injury. Methods: To measure the electrical changes relating to capacitive coupling, the temperature, current, voltage, and impedance around the trocar were measured when an open circuit and a closed circuit were formed using insulation intact instruments and repeated after insulation failure. After the experiment, the tissue around the trocar was collected, and microscopic examination was performed. Results: When open circuits were formed with the intact insulation, the impedance was significantly reduced compared to the cases of closed circuits (142.0 Ω vs. 109.3 Ω, p = 0.040). When the power was 30 W and there was insulation failure, no significant difference was measured between the open circuit and the closed circuit (147.7 Ω vs. 130.7 Ω, p = 0.103). Collagen hyalinization, nuclear fragmentation, and coagulation necrosis suggesting burns were observed in the skin biopsy at the trocar insertion site. Conclusion This study demonstrated that even with a plastic trocar and electrosurgical instruments that have intact insulation, if an open circuit is formed, capacitive coupling increases, and trocar-site burn can occur. When using electrocautery, careful manipulation must be taken to avoid creating an open circuit to prevent capacitive coupling related to electrical skin burn.

Background: The Laboratory Medicine Foundation (LMF) checklists explain the accreditation requirements of the program and reflect quality standards like those of the Clinical Laboratory Standards Institute (CLSI) or quality system essentials (QSE) of the World Health Organization (WHO). In this study, we have analyzed how the LMF checklists correlate with the 12 QSE elements of the WHO. Methods: The LMF checklists for laboratory management (LM) (version 2019) were classified into the 12 specific QSE elements by five laboratory physicians. Each checklist item was classified into specific element if four or more participants agreed, and into overlapping elements when two or more of them agreed for two different items. Any changes in checklist items and chapter structuring of the checklist since 2009 were investigated. Results: The LM checklists consisted of 183 checklist items, including 20 (10.9%) classified into overlapping QSE elements. The QSE element with the highest number of items was the facilities and safety (62, 33.9%), followed by the personnel (22, 12.0%), and the process control (17, 9.3%). In contrast, QSE elements with the lowest number of items were the customer service (4, 2.2%) and process improvement (4, 2.2%). Items belonging to the customer service and the organization elements have increased since 2017. Conclusions The LMF checklists reflect current quality goals for clinical laboratories and play a leading role in the laboratory's quality improvement. The results of our study will be of help in potentiating the quality leader role of LMF checklists, and international harmonization of our laboratory accreditation program.

BACKGROUND: Currently establishment of public pharmaceutical companies became an issue for securing stable supply of national essential drugs in order to respond appropriately to national public health crisis. Pharmacy students as future pharmacists need to be interested in drug related issues under the discussion in our society. This study aimed to investigate perceptions of pharmacy students on the national drug supply strategy through public pharmaceutical companies. METHODS: A 20-items questionnaire designed for this study was used. Pharmacy students nationwide were enrolled in July 2017. They responded to questions through on-line survey program. Data were analyzed descriptively. RESULTS: 160 students from 26 pharmacy schools participated. 5th and 6th grade students accounted for two-thirds, and one third aspired future jobs in pharmaceutical industry. Among responders, 71.3% was unaware of current national essential drugs, 52.5% did not know the Rare and Essential Drug Center, and 91.9% was unaware of the legislation on the supply and management of essential drugs. 82.5% favored the establishment of public pharmaceutical companies. 80.6% agreed that government should intervene in pharmaceutical market for ensuring drug accessibilities, 73.8% agreed that public pharmaceutical companies make possible to reach a goal of stable supply of pharmaceuticals, and 85.1% agreed that active compulsory license by public pharmaceutical companies is necessary. CONCLUSION: We found that pharmacy students recognized the need for governmental control to achieve social values of pharmaceuticals. More attention and participation of the pharmacy students as well as pharmacists in the process of national debate on public pharmaceutical companies are expected.

PURPOSE: This study was performed to investigate the preventable death rate (PDR) in Daegu, South Korea, and to assess both its affecting- and preventable-factors to improve the treatment of regional trauma patients. METHODS: All cases of traumatic death that occurred between January 2012 and December 2012 in five hospitals in Daegu were analyzed retrospectively by a panel review. Cases were classified into preventable (P) and non-preventable deaths (NP). We determined the affecting factors of trauma deaths and preventable factors during trauma care. RESULTS: The PDR was 25.2%. Significant differences by mode of arrival, day of injury, cause of death, and time of emergency department (ED) arrival were observed between P and NP groups. According to the logistic regression analysis, preventability was associated with patients transferred from other hospitals, ED arrival at night and dawn, and non-head injuries. A total of 145 preventable factors were discovered in 59 preventable trauma deaths. When we categorized by location, the ED was the most common, with 71 cases, followed by 57 prehospital preventable factors. When we classified the preventable factors by process, 76.8% were process-related and 23.4% were structure-related. CONCLUSION: Our study is valuable to build an adequate trauma system in Daegu as it provides the baseline quality control data. Efforts to mediate the preventable factors were revealed in this study, and continuous reviews to calculate and track the PDR are needed to evaluate the local trauma system and establish a system specific to Daegu.
Cause of Death ; Daegu* ; Emergency Service, Hospital ; Humans ; Korea* ; Logistic Models ; Mortality* ; Outcome and Process Assessment (Health Care) ; Quality Control ; Retrospective Studies

We used HPLC and AdvanSure real-time PCR (LG Life Sciences, Korea) to retrospectively analyze non-tuberculous mycobacteria (NTM) in 133 clinical specimens. The specimens were culture-positive for NTM and the HPLC method identified 130 strains of mycobacteria from the cultures (97.7%) at the species level. Among the isolates, 48 Mycobacterium. kansasii (36.1%), 39 M. intracellulare (29.3%), 17 M. avium (12.8%), 16 M. abscessus (12.0%), 6 M. fortuitum (4.5%), 2 M. szulgai (1.5%), 2 M. gordonae (1.5%), and 3 unclassified NTM strains (2.3%) were identified. The real-time PCR assay identified 60 NTM-positive specimens (45.1%), 65 negative specimens (48.9%), and 8 M. tuberculosis (TB)-positive specimens (6.0%). The real-time PCR assay is advantageous because of its rapid identification of NTM. However, in our study, the real-time PCR assay showed relatively low sensitivity (45.1%) when using direct specimens including sputum and bronchoalveolar lavage (BAL) fluid. HPLC is useful as it discriminates NTM at the species level, although it is time-consuming and requires specific equipment and technical expertise. A combination of both methods will be helpful for the rapid and accurate identification of mycobacteria in clinical laboratories.
Aged ; Aged, 80 and over ; Bronchoalveolar Lavage Fluid/microbiology ; *Chromatography, High Pressure Liquid ; DNA, Bacterial/genetics ; Female ; Humans ; Male ; Middle Aged ; Mycobacterium/*genetics/isolation & purification ; Mycobacterium Infections/diagnosis/*microbiology ; *Real-Time Polymerase Chain Reaction ; Sputum/microbiology

A slowly growing, non-chromogenic mycobacterial strain was isolated from sputum and bronchial lavage fluid samples of a patient presenting with productive cough, blood-tinged sputum, low-grade fever, and weakness. A positive acid-fast bacilli sputum smear result prompted the initiation of an anti-tuberculosis regimen. Multiplex real-time PCR showed a negative result for Mycobacterium tuberculosis complex and a positive result for nontuberculous mycobacteria. The DNA chip test confirmed this organism as a member of the genus Mycobacterium, but could not specify the species. Interestingly, the mycolic acid patterns obtained by HPLC nearly overlapped with those of M. simulans. The sequences of the Mycobacterium 16S rRNA gene and 16S-23S internal transcribed spacer region were unique and were found to have 100% similarity with those of M. riyadhense. After a review of the literature, we report this case as the first Korean case of M. riyadhense lung infection.
Adult ; Antitubercular Agents/pharmacology ; Chromatography, High Pressure Liquid ; Female ; Humans ; Lung Diseases/*microbiology ; Microbial Sensitivity Tests ; Mycobacterium/classification/drug effects/*isolation & purification ; Mycobacterium Infections/microbiology ; Mycobacterium tuberculosis/genetics/isolation & purification ; Mycolic Acids/analysis ; Oligonucleotide Array Sequence Analysis ; Phylogeny ; RNA, Ribosomal, 16S/chemistry/genetics ; RNA, Ribosomal, 23S/chemistry/genetics ; Republic of Korea ; Sequence Analysis, DNA

BACKGROUND: Bisalbuminemia is a hereditary or an acquired condition characterized by the presence of 2 albumin variants with different mobilities on serum protein electrophoresis (SPE). The clinical significance of bisalbuminemia has not been clearly established. However, some regions of the albumin variant may affect the biochemical analysis of biomolecules such as steroid or thyroid hormones by altering their albumin-binding affinities. In this study, we analyzed the clinical manifestations, genetic variations, and the albumin-binding characteristics in Korean patients with bisalbuminemia. METHODS: We performed SPE for samples from 580 Korean subjects and identified bisalbuminemia on the basis of the results of SPE. The clinical and biochemical characteristics, ALB gene mutations, and the structures of the albumin variants of patients with bisalbuminemia were analyzed. RESULTS: SPE showed bisalbuminemia in 2 patients. One patient showed a genetic variation known as Nagasaki-1 (Asp293Gly) and the other showed a hitherto unreported missense mutation (c.593A>T; Lys198Ile). In both cases, the serum concentrations of the substances with binding affinity for albumin were not affected, and the mutation sites of the albumin were not located with the protein-binding loci. CONCLUSIONS: The 2 Korean patients with bisalbuminemia showed genetic variations, including a novel missense mutation. The ALB gene analysis with 3D modeling is useful for determining the nature of bisalbuminemia and for predicting the effects on the albumin-binding affinity of other biochemical compounds.
Aged ; Amino Acid Substitution ; Asian Continental Ancestry Group/*genetics ; Blood Protein Disorders/diagnosis/*genetics ; Female ; Humans ; Male ; Middle Aged ; Mutation, Missense ; Point Mutation ; Protein Binding ; Protein Structure, Tertiary ; Republic of Korea ; Serum Albumin/*genetics

The quality control for genetic tests would be of great importance as the test volume and clinical demands increase dramatically. Diagnostic genetics subcommitee of KSQACP performed two trials for cytogenetic study in 2008. A total of 41 laboratories participated in the cytogenetic surveys, and most of them showed acceptable results. However, some laboratories showed unacceptable results for the karyotype nomenclature and detection of complex cytogenetic abnormalities in hematologic neoplasias. The molecular genetics surveys included various tests: M. tuberculosis detection, hepatitis B (HBV) and C virus (HCV) detection and quantification, human papilloma virus (HPV) genotyping, gene rearrangement tests for leukemias and lymphomas, apolipoprotein E (APOE) genotyping, methylenetetrahydrofolate reductase (MTHFR) genotyping, hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), and genetic tests for hereditary disorders such as spinal muscular atrophy (SMA), Huntington disease (HD), spinocerebellar ataxia (SCA), Prader-Willi/Angelman syndrome (PWS/AS), mitochondrial encephalopathy with lactic acidosis and strokelike episodes (MELAS), myoclonic epilepsy ragged red fiber (MERRF), wilson disease (ATP7B) and cancer-associated genes (KRAS). Molecular genetic surveys showed excellent results in most of the participants. External quality assessment program for genetic analysis in 2008 was proved to be helpful in continuous education and evaluation of quality improvement.
Acidosis, Lactic ; Apolipoproteins ; Breast ; Chromosome Aberrations ; Cytogenetics ; Epilepsies, Myoclonic ; Gene Rearrangement ; Hepatitis B ; Hepatolenticular Degeneration ; Humans ; Huntington Disease ; Karyotype ; Korea ; Leukemia ; Lymphoma ; Methylenetetrahydrofolate Reductase (NADPH2) ; Mitochondrial Encephalomyopathies ; Molecular Biology ; Muscular Atrophy, Spinal ; Ovarian Neoplasms ; Papilloma ; Quality Control ; Quality Improvement ; Spinocerebellar Ataxias ; Tuberculosis ; Viruses