Background: With increasing life expectancy, the number of older adults with multiple chronic conditions requiring complex medication regimens is growing, raising concerns about polypharmacy and potentially inappropriate medication (PIM) use. This study investigated trends in polypharmacy and PIM use among 66-year-olds in South Korea from 2012 to 2021, considering participant characteristics, to inform interventions and policies. Methods: A repeated cross-sectional study was conducted using the National Health Insurance Services database covering approximately 97% of Koreans. We included 3,397,044 individuals aged 66 who underwent the National Screening Program for Transitional Ages between 2012 and 2021. Polypharmacy was defined as the use of ≥5 medications for ≥90 days annually, hyper-polypharmacy as ≥10 medications, and PIM use as ≥1 PIM for ≥28 days. Trends were analyzed by sex, frailty, comorbidity, income, insurance type, and residence. Results: Polypharmacy prevalence increased from 32.0% in 2012 to 35.4% in 2021, and hyper-polypharmacy also rose. PIM use slightly decreased from 55.7% to 53.7%. Higher rates of polypharmacy and PIM use were observed among rural residents, medical aid beneficiaries, and those with lower income. Despite improvements in comorbidity and frailty, socioeconomic disparities widened, particularly among medical aid beneficiaries. Frequently prescribed PIMs included NSAIDs, PPIs, muscle relaxants, and anxiolytics/hypnotics. Conclusion While PIM use slightly decreased over the study period, it remained above 50%, and polypharmacy prevalence increased among older adults in Korea. Socioeconomic disparities in medication use persist, highlighting the need for targeted interventions and policies to promote safe medication use among vulnerable groups.

Purpose: We aimed to comprehensively analyze the immune cell and stromal components of tumor microenvironment at the single-cell level and identify tumor heterogeneity among the major top-derived oncogene mutations in non-small cell lung cancer (NSCLC) using single-cell RNA sequencing (scRNA-seq) data. Materials and Methods: The scRNA-seq dataset utilized in this study comprised 64369 primary tumor tissue cells from 21 NSCLC patients, focusing on mutations in EGFR, ALK, BRAF, KRAS, TP53, and the wild-type. Results: Tumor immune microenvironment (TIM) analysis revealed differential immune responses across NSCLC mutation subtypes. TIM analysis revealed different immune responses across the mutation subtypes. Two mutation clusters emerged: KRAS, TP53, and EGFR+TP53 mutations (MC1); and EGFR, BRAF, and ALK mutations (MC2). MC1 showed higher tertiary lymphoid structures signature scores and enriched populations of C2-T-IL7R, C3-T/NK-CXCL4, C9-T/NK-NKG, and C1-B-MS4A1 clusters than cluster 2. Conversely, MC2 cells exhibited higher expression levels of TNF, IL1B, and chemokines linked to alternative immune pathways. Remarkably, co-occurring EGFR and TP53 mutations were grouped as MC1. EGFR+TP53 mutations showed upregulation of peptide synthesis and higher synthetic processes, as well as differences in myeloid and T/NK cells compared to EGFR mutations. In T/NK cells, EGFR+TP53 mutations showed a higher expression of features related to cell activity and differentiation, whereas EGFR mutations showed the opposite. Conclusion Our research indicates a close association between mutation types and tumor microenvironment in NSCLC, offering insights into personalized approaches for cancer diagnosis and treatment.

Purpose: By utilizing both protein and mRNA expression patterns, we can identify more detailed and diverse immune cells, providing insights into understanding the complex immune landscape in cancer ecosystems. Materials and Methods: This study was performed by obtaining publicly available Cellular Indexing of Transcriptomes and Epitopes by Sequencing (CITE-seq) data of peripheral blood mononuclear cells (PBMCs) from the Gene Expression Omnibus database. A total of 94674 total cells were analyzed, of which 32412 were T cells. There were 228 protein features and 16262 mRNA features in the data.The Seurat package was used for quality control and preprocessing, principal component analysis was performed, and Uniform Manifold Approximation and Projection was used to visualize the clusters. Protein and mRNA levels in the CITE-seq were analyzed. Results: We observed that a subset of T cells in the clusters generated at the protein level divided better. By identifying mRNA markers that were highly correlated with the CD4 and CD8 proteins and cross-validating CD26 and CD99 markers using flow cytometry, we found that CD4 + and CD8+ T cells were better discriminated in PBMCs. Weighted Nearest Neighbor clustering results identified a previously unobserved T cell subset. Conclusion In this study, we used CITE-seq data to confirm that protein expression patterns could be used to identify cells more precisely. These findings will improve our understanding of the heterogeneity of immune cells in the future and provide valuable insights into the complexity of the immune response in health and disease.

Systemic amyloidosis is characterized by the accumulation of insoluble proteins in tissues including heart, kidney, liver and any other organs. Light chain amyloidosis is the most common type of primary amyloidosis. And it is generally considered to be the plasma cell dysfunction. Given its pathogenesis, it may affect any organ system. Thus, clinical presentation is variable and delayed diagnosis is common. Given these diagnostic difficulties, we presented a systemic amyloidosis presented as liver dysfunction.

Gallbladder tumors are rare but aggressive malignancies, often identified incidentally after cholecystectomy. Adenocarcinoma is the most common phenotype, though squamous cell carcinoma is rare, and it ranged as 1–4% of reported gallbladder cancer. Due to the rarity of the disease, early diagnosis is often challenging. One of the uncommon presentations of gallbladder cancer is hepatic abscess, with few cases reported in the literature. This report presents a rare case of an 82-year-old male referred with hepatic abscess. Multiple pathogens were isolated, indicating a superimposed bacterial infection. Upon further investigation, cytology confirmed the presence of a keratinizing squamous carcinoma of gallbladder cancer. This case presents a rare instance of squamous cell gallbladder carcinoma, which is difficult to diagnose, discovered in an elderly patient who presented with a liver abscess accompanied by bacterial infection. It highlights the challenges in diagnosis and treatment, as well as the poor prognosis associated with the condition.

Purpose: We aimed to comprehensively analyze the immune cell and stromal components of tumor microenvironment at the single-cell level and identify tumor heterogeneity among the major top-derived oncogene mutations in non-small cell lung cancer (NSCLC) using single-cell RNA sequencing (scRNA-seq) data. Materials and Methods: The scRNA-seq dataset utilized in this study comprised 64369 primary tumor tissue cells from 21 NSCLC patients, focusing on mutations in EGFR, ALK, BRAF, KRAS, TP53, and the wild-type. Results: Tumor immune microenvironment (TIM) analysis revealed differential immune responses across NSCLC mutation subtypes. TIM analysis revealed different immune responses across the mutation subtypes. Two mutation clusters emerged: KRAS, TP53, and EGFR+TP53 mutations (MC1); and EGFR, BRAF, and ALK mutations (MC2). MC1 showed higher tertiary lymphoid structures signature scores and enriched populations of C2-T-IL7R, C3-T/NK-CXCL4, C9-T/NK-NKG, and C1-B-MS4A1 clusters than cluster 2. Conversely, MC2 cells exhibited higher expression levels of TNF, IL1B, and chemokines linked to alternative immune pathways. Remarkably, co-occurring EGFR and TP53 mutations were grouped as MC1. EGFR+TP53 mutations showed upregulation of peptide synthesis and higher synthetic processes, as well as differences in myeloid and T/NK cells compared to EGFR mutations. In T/NK cells, EGFR+TP53 mutations showed a higher expression of features related to cell activity and differentiation, whereas EGFR mutations showed the opposite. Conclusion Our research indicates a close association between mutation types and tumor microenvironment in NSCLC, offering insights into personalized approaches for cancer diagnosis and treatment.

Vitiligo, an autoimmune skin disease, is primarily driven by interferon-γ-CXCL10 signaling involving autoreactive CD8＋ T cells targeting melanocytes. Although the pathogenesis of segmental vitiligo remains unclear, recent insights suggest neural, somatic mosaicism, and microvascular mechanisms as possible explanations. Here, we present a case of a 5-year-old boy with a café au lait macule that transformed into a hypopigmented patch, suggestive of segmental vitiligo. Biopsies showed early vitiligo features in the hypopigmented area, where there was high prevalence of CD8＋ T cells, accompanied by CXCL10 expression. Growing evidence supports the autoimmune basis and cutaneous mosaicism in segmental vitiligo, with this case highlighting the role of vulnerable melanocytes, autoimmune attack, and the abrupt loss of repigmentation post-treatment. This case adds weight to the autoimmune and mosaicism theories in segmental vitiligo pathogenesis.

Objectives: This paper provides evidence for the improvement of the local and national longterm psychiatric emergency response system by analyzing emergency response cases for psychiatric crisis intervention conducted over three years at the Jeonbuk State Mental Health Welfare Center. Methods: From August 1, 2020, to December 31, 2023, 314 cases of emergency response for psychiatric crisis intervention were analyzed. The analysis included factors such as gender, age, marital status, location, classification of psychiatric crises, referral pathways, intervention response time, counseling history, location of intervention, types of mental health issues, types of suicidal issues, psychiatric treatment history, suicide plans and attempts, outcomes of major interventions, levels of depression, alcohol consumption, and suicidal behavior. Results: The emergency response for psychiatric crisis intervention had a higher proportion of suicide counseling compared to general mental health emergencies, and most cases were referred through administrative agencies such as the police and fire department. The majority of intervention targets were first-time counselees, classified as high-risk individuals because of depression, alcohol consumption, and suicidal behavior, and either discontinued or were maintaining medication treatment. Conclusion This study illustrated the major role of emergency response in psychiatric crisis intervention and the need for strengthening networks with police, fire departments, and relevant agencies, and improving the treatment of care staff and public awareness. In addition, this study provides evidence for predicting risk factors and offering preventive and preemptive measures.