Objective: This study aimed to examine the associations between multiple modifiable risk/protective factors and the onset of cognitive impairment, using nationally representative panel data spanning 10 years. Methods: A total of 7,568 respondents who were cognitively normal at baseline were included and followed up for 10 years using data from the 2006–2016 Korean Longitudinal Study of Ageing. The data were converted into 28,113 person-year observations, and a life table approach and a series of event history models were used to estimate the transition rates to cognitive impairment over time and to examine the influence of time-varying factors on the onset of cognitive impairment. Cognitive impairment was measured using the Korean version of the Mini-Mental State Exam. Results: About half of the respondents without cognitive impairment at baseline had experienced cognitive impairment by the end of the last interview, and women were more likely than men to experience cognitive impairment during the observation period. Vascular risk factors, hearing loss, socioeconomic status, regular exercise, participation in social activities, and frequent contact with close friends were significantly associated with the onset of cognitive impairment. Conclusion This investigation of modifiable factors for cognitive impairment using population-based data may lead to the identification of preventive strategies that people could integrate into their lifestyles.

Objective: This study aimed to investigate the association between positive marital quality and cognitive health over time and to examine gender differences in this association. Methods: Drawing on 2006–2018 Korean Longitudinal Study of Aging data (n=7,427 respondents, 35,066 person-year observations), a series of hybrid mixed-effects models were used to estimate the effects of time-invariant (gender) and time-variant (marital quality) variables on within-person changes and on between-person differences in cognitive decline over the observation period. Results: The results showed that individuals’ likelihood of having higher cognitive health grew when their spousal relationship became more positive and that, compared with those with lower levels of marital quality, people with higher levels of marital quality were more likely to have higher cognitive health. Interestingly, improvements in marital quality were more beneficial for men than for women, whereas level of marital quality had similar effects on men’s and women’s cognitive health. Conclusion Couple-based intervention programs aiming to improve marital quality should be encouraged, especially among older adults.

BACKGROUND: Human metapneumovirus (hMPV) is a relatively recently identified respiratory virus that induces respiratory symptoms similar to those of respiratory syncytial virus infection in children. The characteristics of hMPV-infected adults are unclear because few cases have been reported. METHODS: We conducted a retrospective review of hospitalized adult patients with a positive multiplex real-time polymerase chain reaction assay result from 2012 to 2016 at a single tertiary referral hospital in South Korea. We analyzed clinical characteristics of the enrolled patients and divided patients into an acute respiratory distress syndrome (ARDS) group and a non-ARDS group. RESULTS: In total, 110 adults were reviewed in this study. Their mean age was 61.4 years, and the majority (n = 105, 95.5%) had comorbidities or were immunocompromised. Most of the patients had pneumonia on chest X-ray (n = 88, 93.6%), 22 (20.0%) had ARDS, and 12 (10.9%) expired during hospitalization. The mortality rate for patients with ARDS was higher than that of the other patients (36.4% vs. 5.7%, P = 0.001). The risk factor for hMPV-associated ARDS was heart failure (odds ratio, 5.24; P = 0.044) and laboratory values were increased blood urea nitrogen and increased C-reactive protein. The acquisition site of infection was divided into community vs. nosocomial; 43 patients (39.1%) had a nosocomial infection. The risk factors for nosocomial infection were an immunocompromised state, malignancy and immunosuppressive treatment. CONCLUSIONS: These data suggest that hMPV is one of the important respiratory pathogens important respiratory pathogen that causes pneumonia/ARDS in elderly, immunocompromised individuals and that it may be transmitted via the nosocomial route.
Adult* ; Aged ; Blood Urea Nitrogen ; C-Reactive Protein ; Child ; Comorbidity ; Cross Infection ; Heart Failure ; Hospitalization ; Humans* ; Korea ; Metapneumovirus* ; Mortality* ; Pneumonia ; Real-Time Polymerase Chain Reaction ; Respiratory Distress Syndrome, Adult* ; Respiratory Syncytial Viruses ; Retrospective Studies* ; Risk Factors ; Tertiary Care Centers ; Thorax

Publication lag is a determinant to journal efficiency that was not yet studied concerning Korean medical journals. To measure publication lag, we investigated the publication timestamps of 4,762 articles published by 10 Korean medical journals indexed in Scopus database, randomly selected from the KoreaMed Synapse since 2013. The total publication lag was 246.5 (Q1, Q3; 178.0, 347.0) days. The overall acceptance lag was 102.0 (65.0, 149.0) days. The overall lead lag was 123.0 (63.0, 236.0) days. The year of publication did not significantly affect the acceptance lag (P = 0.640), supposedly shortening it by about 1.4 (97.5% confidence interval [CI], −5.2 to 8.0) days/year, while the date affected the lead lag (P = 0.028), shortening it by about 12.9 (1.3 to 24.5) days/year. The Korean medical journals have reduced the total publication delay entirely by means of reducing the lead lag, not by reducing the acceptance lag.
Bibliometrics ; Peer Review ; Publications* ; Synapses

Dear Editor, Acute promyelocytic leukemia (APL) is a subtype of acute myelocytic leukemia, characterized by the chromosomal abnormality t(15:17) coding a PML/RAR alpha fusion protein that affects differentiation of the promyelocyte cell in bone marrow. All-trans retinoic acid (ATRA), a key treatment for APL, acts as a differentiating agent in combination with other induction chemotherapy. Differentiation syndrome (DS) is a complication in APL patients undergoing induction chemotherapy with ATRA or arsenic trioxide [1]. The pathophysiology of DS is not understood precisely; however, it appears to be associated with a large pool of leukemic blasts, massive tissue infiltration of cells, cytokine increase, and systemic capillary leak syndrome, clinically presenting as dyspnea, fever, peripheral edema, weight gain, pleural, pericardial effusion, and acute kidney injury [2,3]. We present the case of a 66-year-old woman experiencing visual discomfort after starting ATRA treatment. This case highlights that visual symptoms can arise earlier than other well-known life-threatening symptoms of DS. A 66-year-old female patient presented with a fourmonth history of headaches, nausea, and vomiting. Blood tests revealed pancytopenia, and bone marrow examination confirmed PML/RARA gene positive. She was diag-nosed with APL for the first time and was admitted to the Department of Hematology and Medical Oncology at Ewha Womans University Mokdong Hospital for induction chemotherapy, where she received cytarabine, idarubicin, and ATRA as her induction chemotherapy treatment. Five days after ATRA treatment, she was referred for visualdimness and peripheral blurred vision. Her medical history included hypertension and branched retinal vein occlusion in her left eye, which had been treated with intravitreal injections three times two years prior. Her corrected visual acuity was 20 / 40 in the right eye and 20 / 32 in the left eye. Anterior segment finding was normal except for mild nuclear sclerosis in both eyes. Funduscopic examination revealed multiple retinal hemorrhages on the posterior pole in both eyes and Roth’s spot appearance in the left eye. Spectral-domain optical coherence tomography showed subretinal fluid (SRF) in the macula area of the right eye (Fig. 1A). Two days after ocular symptoms appeared, systemic DS symptoms, such as fever, weight gain, and dyspnea appeared, and pulmonary edema was evident in her chest x-ray. As a DS treatment protocol, intravenous dexamethasone was administered for 12 days. Two weeks later after the diagnosis of DS, SRF in macula became more aggravated, with involvement of the fellow eye, while ocular symptoms persisted. Twenty days after DS diagnosis, bilateral serous retinal detachment (SRD) was observed.However, fluorescein angiography showed no significant abnormality, with the exception of a previous branch retinal vein occlusion lesion in her left eye (Fig. 1B); the anterior segment was not remarkable. Her symptoms continued for about 1 month under ATRA treatment and slowly regressed with visual recovery in parallel with discontinuing ATRA (Fig. 1C). Two days after discontinuing ATRA, minimal SRF remained on her right eye. Two weeks later, her corrected visual acuity was 20 / 20 in the right eye and 20 / 25 in the left eye. She achieved complete remission of SRD with improvement in visual symptoms (Fig. 1D). We report the case of DS with ocular manifestation as a first symptom. Ocular manifestation of DS has been reported several times in previous case reports, involving retinal hemorrhage, SRD with intraretinal fluid, choroidal effusion, pseudotumor cerebri, and optic disc edema [2,4,5]. SRD can also appear in ocular infection, inflammatory disease, retinal vascular disease, malignancy, and leukemic retinopathy. Therefore, differential diagnosis should be considered. However, in this patient, the ocular symptom had developed after using the differentiating agent, ATRA. Systemic symptom appeared later. Anterior segments and fluorescein angiography findings were unre-markable to consider other differential diagnoses. After ceasing ATRA, bilateral SRD on optical coherence tomography was regressed, and the patient’s symptom was also relieved.In conclusion, patients receiving ATRA treatment may first present with acute visual symptoms, followed by life-threatening complications such as fever, dyspnea, peripheral edema, and weight gain. Thus, careful observation of ocular symptoms in APL patients is of the utmost importance if the patient is undergoing ATRA treatment.

A university’s admission policy is established to select applicants who can successfully complete the curriculum. Thus, it is important to develop optimal admissions processes for applicant selection. This study was conducted to infer the most suitable admission processes for veterinary school applicants by examining academic achievement, graduation competency and academic sustainability. It was conducted on students admitted from 2009 to 2018 at one of the veterinary colleges in Korea. The admission methods were divided into, first the regular admission (RA) process, primarily reflecting the results of the College Scholastic Ability Test, and second, the rolling admission processes. The rolling processes were further divided into admission officer-based (AO), high school grade point average-based (GA), essay test-based (ET), admission for the underprivileged (UP) and admission for overseas Koreans and foreigners (OKF). The final grade point average was observed to be higher in the order of the GA, AO and RA groups. The survey on the veterinary graduation competency did not reveal any difference between the regular and rolling admission processes. However, among the latter, AO-based admission showed a higher ratio of outstanding competency levels. In terms of academic sustainability, OKF admission demonstrated a higher rate of failure while RA showed a higher rate of expulsion and dropout. Summarizing the above results, the most successful veterinary applicants were selected through AO-based admission. These results are meaningful in providing the basic information required to establish admission policies for veterinary colleges in Korea.

A university’s admission policy is established to select applicants who can successfully complete the curriculum. Thus, it is important to develop optimal admissions processes for applicant selection. This study was conducted to infer the most suitable admission processes for veterinary school applicants by examining academic achievement, graduation competency and academic sustainability. It was conducted on students admitted from 2009 to 2018 at one of the veterinary colleges in Korea. The admission methods were divided into, first the regular admission (RA) process, primarily reflecting the results of the College Scholastic Ability Test, and second, the rolling admission processes. The rolling processes were further divided into admission officer-based (AO), high school grade point average-based (GA), essay test-based (ET), admission for the underprivileged (UP) and admission for overseas Koreans and foreigners (OKF). The final grade point average was observed to be higher in the order of the GA, AO and RA groups. The survey on the veterinary graduation competency did not reveal any difference between the regular and rolling admission processes. However, among the latter, AO-based admission showed a higher ratio of outstanding competency levels. In terms of academic sustainability, OKF admission demonstrated a higher rate of failure while RA showed a higher rate of expulsion and dropout. Summarizing the above results, the most successful veterinary applicants were selected through AO-based admission. These results are meaningful in providing the basic information required to establish admission policies for veterinary colleges in Korea.

A university’s admission policy is established to select applicants who can successfully complete the curriculum. Thus, it is important to develop optimal admissions processes for applicant selection. This study was conducted to infer the most suitable admission processes for veterinary school applicants by examining academic achievement, graduation competency and academic sustainability. It was conducted on students admitted from 2009 to 2018 at one of the veterinary colleges in Korea. The admission methods were divided into, first the regular admission (RA) process, primarily reflecting the results of the College Scholastic Ability Test, and second, the rolling admission processes. The rolling processes were further divided into admission officer-based (AO), high school grade point average-based (GA), essay test-based (ET), admission for the underprivileged (UP) and admission for overseas Koreans and foreigners (OKF). The final grade point average was observed to be higher in the order of the GA, AO and RA groups. The survey on the veterinary graduation competency did not reveal any difference between the regular and rolling admission processes. However, among the latter, AO-based admission showed a higher ratio of outstanding competency levels. In terms of academic sustainability, OKF admission demonstrated a higher rate of failure while RA showed a higher rate of expulsion and dropout. Summarizing the above results, the most successful veterinary applicants were selected through AO-based admission. These results are meaningful in providing the basic information required to establish admission policies for veterinary colleges in Korea.

A university’s admission policy is established to select applicants who can successfully complete the curriculum. Thus, it is important to develop optimal admissions processes for applicant selection. This study was conducted to infer the most suitable admission processes for veterinary school applicants by examining academic achievement, graduation competency and academic sustainability. It was conducted on students admitted from 2009 to 2018 at one of the veterinary colleges in Korea. The admission methods were divided into, first the regular admission (RA) process, primarily reflecting the results of the College Scholastic Ability Test, and second, the rolling admission processes. The rolling processes were further divided into admission officer-based (AO), high school grade point average-based (GA), essay test-based (ET), admission for the underprivileged (UP) and admission for overseas Koreans and foreigners (OKF). The final grade point average was observed to be higher in the order of the GA, AO and RA groups. The survey on the veterinary graduation competency did not reveal any difference between the regular and rolling admission processes. However, among the latter, AO-based admission showed a higher ratio of outstanding competency levels. In terms of academic sustainability, OKF admission demonstrated a higher rate of failure while RA showed a higher rate of expulsion and dropout. Summarizing the above results, the most successful veterinary applicants were selected through AO-based admission. These results are meaningful in providing the basic information required to establish admission policies for veterinary colleges in Korea.