Background: The Democratic People’s Republic of Korea (North Korea) had successfully suppressed the coronavirus disease 2019 (COVID-19) epidemic via border closures. However, a rapid surge in incidence was reported due to the spread of the omicron variant (B.1.1.529), leading to a national emergency declaration in May 2022. Moreover, with the lack of vaccine accessibility and medical facilities, it is unclear how the disease burden may be exacerbated. Despite the limited epidemiological data, we aimed to project the COVID-19 transmissions in North Korea and quantify the potential impact of nationwide vaccination, comparing epidemiological outcomes via scenario analysis. Methods: A discrete-time deterministic compartmental model was used. The parameters were calibrated using empirical data. Numerical simulations incorporated nationwide COVID-19 vaccination into the proposed model with various asymptomatic proportions. Results: Our model suggested that the stringent public health and social measures (PHSMs) reduced the severe acute respiratory syndrome coronavirus 2 transmissibility by more than 80% in North Korea. Projections that explicitly incorporated vaccination indicated that nationwide vaccination would be necessary to suppress a huge resurgence in both COVID-19 cases and hospitalizations after the stringent PHSMs are eased. Moreover, vaccinating more than 80% of the population with two doses may keep the peak prevalence of hospitalizations below 1,500, averting more than 40,000 hospitalizations across all scenarios. Conclusion Nationwide vaccination would be essential to suppress the prevalence of COVID-19 hospitalizations in North Korea after the stringent PHSMs are lifted, especially in the case of a small asymptomatic proportion.

No abstract available.

OBJECTIVE: The changes of the production of nitric oxide in preeclampsia are still controversial. To determine the changes of nitric oxide production in preeclamptic pregnancies, NOS activity and eNOS and iNOS expression in preeclamptic placentae were compared with those in normal placentae, and to determine the changes of nitirc oxide production according to the sites of placenta, NOS activity and eNOS expression in preeclamptic placentae were also compared with those in normal placentae. METHODS: Human placentae were obtained from 15 normal and 15 preeclamptic pregnant women at the time of cesarean section. NOS activity was assessed by measuring the conversion of [3H]-arginine into [3H]-citrulline. The eNOS and iNOS expression were assessed by using western blot analysis. Data were analyzed by Student t-test and paired t-test where appropriate. RESULTS: The NOS activity(judged by measurement of [3H]-citrulline production) was significantly increased in preeclamptic placentae compared to normal(P<0.05). In normal and preeclamptic pregnant placentae, the NOS activity in main stem villi was increased compared to that in terminal villi. However, the difference of NOS activity between main stem villi and terminal villi was not significant(P>0.05). Quantification of the autoradiographic images demonstrated that the integrated optical density of the immunoreactive bands of eNOS were significantly lower in preeclamptic placentae compared to normal(p<0.05). Conversely, the integrated optical densities of the bands of iNOS were significantly higher in preeclamptic placentae compared to normal(p<0.05). CONCLUSIONS: Although the eNOS expression in preeclamptic placentae was lower than that in normal placentae, the NOS activity was significantly higher in preeclamptic placentae than that in normal in this study. These are result from increased production of iNOS in the compensatory mechanisms for the decreased nitric oxide production in pre-eclamptic placentae.
Blotting, Western ; Cesarean Section ; Female ; Humans* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Placenta* ; Pre-Eclampsia ; Pregnancy* ; Pregnant Women

Mutations in the tumor suppressor p53 gene are the most frequently observed genetic lesions in human cancers. It seems that wild type p53 does significant role on growth and differentiation of normal cells, Mutations and allelic loss of the p53 gene are thought to be a cause of tumor development and to be correlated with the prognostic factors in various human cancers such as breast, ovary and lung cancer. Mutant p53 proteins have a prolonged half-life and can be detected by immunohistochemistry. In case of GTD(gestational trophoblastic disease), although the mutation of p53 gene mutation was revealed to be very rare, the overexpression of p53 in immunohistochemical staining has been reported in wide range of discrepancy and its role or prognostic significance in GTD is uncertain. This study is performed to define the status of p53 overexpression in GTD and to evaluate the correlations between p53 overexpression and prognostic factors of GTD. THE RESULTS WERE AS FOLLOWS: 1. p53 overexpression was detected in none of normal placental tissue, in 58.3%(14/24) of hydatidiform mole, in 15%(6/8) of invasive mole, in 75%(3/4) of choriocarcinoma, and in 100%(1/1) of placental site trophoblastic tumor, and showed significant difference between normal placenta and GTD. We could not find any difference of the p53 overexpression between benign group(H-mole) of GTD and malignant one(invasive mole, choriocarcinoma, and placental site trophoblastic tumor) 2. In H-mole, low-risk group showed significantly higher prevalence of p53 overexpression than high-risk group did. In malignant group, there is no difference in the prevalence of p53 overexpression between early(FIGO stage I) and late(II- IV)stage-diseases, but the prevalence of p53 overexpression of low-risk group is slightly higher than that of high-risk group although we failed to find statistical significance. In conclusion, the high prevalence of p53 overexpression in GTD suggests that p53 may have a certain role in the pathogenesis of GTD or at least represent generalized DNA damage or genetic instability of GTD. And the higher prevalence of p53 overexpression in low-risk group suggests that accumulation of wild-type p53 may be related with favorable prognosis in GTD.
Breast ; Choriocarcinoma ; DNA Damage ; Female ; Genes, p53 ; Gestational Trophoblastic Disease* ; Half-Life ; Humans* ; Hydatidiform Mole ; Hydatidiform Mole, Invasive ; Immunohistochemistry ; Loss of Heterozygosity ; Lung Neoplasms ; Ovary ; Placenta* ; Pregnancy ; Prevalence ; Prognosis ; Trophoblastic Tumor, Placental Site ; Trophoblasts

Malignant germ cell tumore occur in children and young women in reproductive age, of all the germ cell maligaanci orily pure dysgerminiomas had a high cure rate prior to 1970. This was due to the exquisite wdioseneitivity of these tumors. Multiple agent chemotherapy has dramatieally improved the pr nosis af patients with malignant ovarian germ cell tumors. The purpose of this study is to report the experience at Aaan Medical Center, department of Obstetrics and Gynecology, in 16 patients withmalignant ovarian germ cell tumors treated between July, l989 and June, l994. We analyzed the effect of age, histolagic subtype, FIGO stage, surgical pmcedurse and regimens of chemotherapy, on the prognosis of thwe tumors. The results obtained were as follows: 1. In histologic subtypes, dysgenninoma(38.0%), endodermal sinus tumor(25.0%), squamous cell carcinoma arising in mature cystic teratoma(19.0%), mixed cell tumor(6.0%), immature teratoma(6.0%), malignant ectodermal tumor in mature cystic teratoma(6.0%), were counted in order. 2. No site predilection was identifed. 3. Main initial symptoms were abdominal distension(31.0%), abdominal pain(31.0%), abdominal mass palpation(25.0%), amenorrhea(6.0%) in order. 4. Multiple tumor markers were considered to be useful in diagnosis and follow up of malignant germ cell tumors of ovary. 5. The mean age of malignant ovarian germ cell tumors was 29.5 years, and 11 cases(69.3%) of tumors under the age of 30.0 years. 6. The survival rate seemed to be decreased with advancing FIGO stage.
Carcinoma, Squamous Cell ; Child ; Diagnosis ; Drug Therapy ; Ectoderm ; Endoderm ; Female ; Follow-Up Studies ; Germ Cells* ; Gynecology ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Obstetrics ; Ovary* ; Prognosis ; Survival Rate ; Biomarkers, Tumor

Fetal bilateral renal agenesis is a lethal congenital anomaly. An early and reliable prenatal diagnosis is extremely important as it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, and the empty renal fossae. However, severe oligohydramnios makes it difficult to diagnose the disease because of poor sonographic resolution. We present a case of fetal bilateral renal agenesis diagnosed by ultrasonography after amnioinfusion at 19 weeks gestation.
Diagnosis ; Female ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography ; Ultrasonography, Prenatal* ; Urinary Bladder

Werniche's encephalopathy is clinically characterized by the acute onset of global confusion, ataxia, gaze paresis, and nystagmus. It result from a deficiency in thiamine, an essential coenzyme in intermediate carbohydrate metabolism. The prompt use of thiamine prevents progression of the disease and reverses those lesions that have not yet progressed to the point of fixed structural change. We experienced a case of Wemiches encephalopathy associated with hyperemesis gravidarum, which happens to the patient who are injected only dextrose without thiamine. Therefore, we emphasize the need of thiamine replacement in hyperemesis gravidarum.
Ataxia ; Carbohydrate Metabolism ; Female ; Glucose ; Humans ; Hyperemesis Gravidarum ; Paresis ; Pregnancy ; Thiamine

Farber disease (FD) is a rare lysosomal storage disorder that shows autosomal recessive inheritance. We report the case of a 58-month-old girl with FD, who was misdiagnosed with epithelioid hemangioendothelioma. The patient had undergone five surgeries for sacrococcygeal masses and three surgeries for scalp masses owing to misdiagnosis. Here, we describe this rare case of FD.
Diagnostic Errors ; Farber Lipogranulomatosis* ; Female ; Hemangioendothelioma* ; Hemangioendothelioma, Epithelioid ; Humans ; Scalp ; Wills

We report a case of cardiac lymphoma in a 40-year-old man, who had a mediastinal mass which was diagnosed as sclerosing mediastinitis pathologically. The mediastinal mass caused right pulmonary arterial stenosis. The patient developed myocardial hypertrophy and echocardiography showed restrictive physiology and severely decreased left ventricle ejection fraction, 6 months later. MRI showed global left ventricular myocardial hypertrophy and diffuse late gadolinium hyperenhancement after administration of contrast material. Thus, non-ischemic cardiomyopathy was suspected on MRI. However, pathology confirmed the myocardial abnormality as lymphoma after myocardial biopsy. Because a basal part of the left ventricle and global subendocardial myocardium were not involved on contrast-enhanced delayed MRI, the MRI abnormalities could be differentiated from amyloidosis and other myocardial diseases. The peculiar non-mass forming diffuse hypertrophy pattern of cardiac lymphoma has not been known in the MRI literature.
Adult ; Amyloidosis ; Biopsy ; Cardiomyopathies ; Constriction, Pathologic ; Echocardiography ; Gadolinium ; Heart Ventricles ; Humans ; Hypertrophy ; Lymphoma ; Mediastinitis ; Myocardium ; Sclerosis

BACKGROUND: The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock. METHODS: We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality. RESULTS: Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]). CONCLUSIONS: Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.
Arterial Pressure ; Consensus* ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Emergencies* ; Emergency Service, Hospital* ; Hemostasis ; Humans ; Hypotension ; Lactic Acid ; Logistic Models ; Mortality ; Prevalence* ; Retrospective Studies ; Shock, Septic* ; Survivors ; Tertiary Healthcare ; Thrombosis