Purpose: Stem cell-based therapies are considered an alternative approach for critical limb ischemia (CLI) patients with limited or exhausted options, yet their clinical use is limited by the lack of sustainability and unclear mechanism of action.In this study, a substance P-conjugated scaffold was injected with mesenchymal stem cells (MSCs) into an animal model of CLI to verify whether angiogenesis could be enhanced. Methods: A self-assembling peptide (SAP) was conjugated with substance P, known to have the ability to recruit host stem cells into the site of action. This SAP was injected with MSCs into ischemic hindlimbs of rats, and the presence of MSCs was verified by immunohistochemical (IHC) staining of MSC-specific markers at days 7, 14, and 28. The degree of angiogenesis, cell apoptosis, and fibrosis was also quantified. Results: Substance P-conjugated SAP was able to recruit intrinsic MSCs into the ischemic site of action. When injected in combination with MSCs, the presence of both injected and recruited MSCs was found in the ischemic tissues by double IHC staining. This in turn led to a higher degree of angiogenesis, less cell apoptosis, and less tissue fibrosis compared to the other groups at all time points. Conclusion The combination of substance P-conjugated SAP and MSCs was able to enhance angiogenesis and tissue repair, which was achieved by the additive effect from exogenously administered and intrinsically recruited MSCs. This scaffold-based intrinsic recruitment approach could be a viable option to enhance the therapeutic effects in patients with CLI.

Background: Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated. Methods: From the multicenter PTRG-DES (Platelet function and genoType-Related long-term prognosis in DES-treated patients) consortium, the patients were classified as preserved-EF (PEF: LVEF ≥ 50%) and reduced-EF (REF: LVEF< 5 0%) group by echocardiography. Platelet reactivity was measured using VerifyNow P2Y 12 assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3–5. Results: A total of 13,160 patients from PTRG-DES, 9,319 (79.6%) patients with the results of both PRU and LVEF were analyzed. The incidence of MACCE and major bleeding was higher in REF group as compared with PEF group (MACCEs: hazard ratio [HR] 2.17, P < 0.001, 95% confidence interval [CI] 1.85–2.55; major bleeding: HR 1.78, P < 0.001, 95% CI 1.39–2.78).The highest rate of MACCEs was found in patients with REF and HPR, and the difference between the groups was statistically significant (HR 3.14 in REF(+)/HPR(+) vs. PEF(+)/HPR(-) group,P <0.01, 95% CI 2.51–3.91). The frequency of major bleeding was not associated with the HPR in either group. Conclusion LV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry.Trial Registration: ClinicalTrials.gov Identifier: NCT04734028

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

Objective: This study aimed to explore the characteristics and factors related to changes in cognitive function in vulnerable individuals with cognitive impairment during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Among patients who visited a local university hospital with subjective cognitive complaints, those who had been tested for cognitive function at least once after the onset of COVID-19 and tested regularly at least three times within the last 5 years were included (1st, the initial screening; 2nd, the test immediately before the COVID-19 pandemic; 3rd, the most recent test after the pandemic). Finally, 108 patients were included in this study. They were divided into groups according to whether the Clinical Dementia Rating (CDR) was maintained/improved and deteriorated. We investigated the characteristics of the changes in cognitive function and related factors during COVID-19. Results: When comparing CDR changes before and after COVID-19, there was no significant difference between the two groups (p=0.317). Alternatively, the main effect of the time when the test was conducted was significant (p<0.001). There was also a significant difference in the interaction between the groups and time. When the effect of the interaction was analyzed, the CDR score of the maintained/ improved group significantly decreased before COVID-19 (1st–2nd) (p=0.045). After COVID-19 (2nd–3rd), the CDR score of the deteriorated group was significantly higher than that of the maintained/improved group (p<0.001). Mini-Mental State Examination recall memory and changes in activity during COVID-19 were significantly associated with CDR deterioration. Conclusion Memory dysfunction and decreased activity during the COVID-19 pandemic are strongly related to the deterioration of cognitive impairment.

BACKGROUND: Hepatitis B virus (HBV) infection leads to hepatic and extrahepatic manifestations including chronic kidney disease (CKD). However, the association between HBV and CKD is not clear. This study investigated the association between chronic HBV infection and CKD in a nationwide multicenter study. METHODS: A total of 265,086 subjects who underwent health-check examinations in 33 hospitals from January 2015 to December 2015 were enrolled. HBV surface antigen (HBsAg) positive cases (n = 10,048), and age- and gender-matched HBsAg negative controls (n = 40,192) were identified. CKD was defined as a glomerular filtration rate (GFR) < 60 mL/min/1.73 m² or proteinuria as at least grade 2+ of urine protein. RESULTS: HBsAg positive cases showed a significantly higher prevalence of GFR < 60 mL/min/1.73 m² (3.3%), and proteinuria (18.9%) than that of the controls (2.6%, P < 0.001, and 14.1%, P < 0.001, respectively). In the multivariate analysis, HBsAg positivity was an independent factor associated with GFR < 60 mL/min/1.73 m² along with age, blood levels of albumin, bilirubin, anemia, and hemoglobin A1c (HbA1c). Likewise, HBsAg positivity was an independent factor for proteinuria along with age, male, blood levels of bilirubin, protein, albumin, and HbA1c. A subgroup analysis showed that HBsAg positive men but not women had a significantly increased risk for GFR < 60 mL/min/1.73 m². CONCLUSION: Chronic HBV infection was significantly associated with a GFR < 60 mL/min/1.73 m² and proteinuria (≥ 2+). Therefore, clinical concern about CKD in chronic HBV infected patients, especially in male, is warranted.
Anemia ; Antigens, Surface ; Bilirubin ; Case-Control Studies* ; Female ; Glomerular Filtration Rate ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Male ; Multivariate Analysis ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic*

BACKGROUND AND OBJECTIVES: Even patients with compensated peripheral vestibular dysfunction may report a sense of disequilibrium during daily activities, which often fail conventional vestibular function tests as attentional demand required for postural control may increase in these patients. The study aims to assess the feasibility of dual task test using concurrent cognitive tasks in a modified clinical test of sensory interaction on balance (mCTSIB) to measure increased attentional demand for posture control. SUBJECTS AND METHOD: Nineteen patients suspected with chronic dizziness were recruited by history reviews and physical examinations. Data for center of pressure (COP) variability and mean velocity during mCTSIB on a force long plate were analyzed, and time taken to react to the auditory stimuli were used to measure the attentional demand required for adequate postural control during platform perturbation. RESULTS: The mean COP range and velocity during mCTSIB were comparable between single and dual task conditions in patients with dizziness. Reaction time (RT) to auditory stimulus of 1 kHz pure tone in patients with chronic dizziness was also comparable to normal subjects. Interestingly, there was a tendency for increased RT in patients with documented caloric weakness, suggesting that attentional demand is increased in these patients. CONCLUSION: RT of dual task tests using auditory stimuli during mCTSIB may provide additional information about increased attentional demand for postural control in patients with vestibular dysfunction.
Dizziness* ; Humans ; Methods ; Physical Examination ; Posture ; Reaction Time ; Task Performance and Analysis ; Vestibular Diseases ; Vestibular Function Tests

Aortic aneurysm is a common and life-threatening disease that can cause death from rupture. Current therapeutic options are limited to surgical or endovascular procedures because no pharmacological approaches have been proven to decrease the chance of expansion or rupture. The best approach to the management of aortic aneurysm would be the understanding and prevention of the processes involved in disease occurrence, progression, and rupture. There is a need for animal models that can reproduce the pathophysiological features of human aortic aneurysm, and several such models have been studied. This review will emphasize recent advances in animal models used in the determination of mechanisms and treatments of aortic aneurysms.
Aneurysm ; Aorta ; Aortic Aneurysm* ; Endovascular Procedures ; Humans ; Models, Animal* ; Rupture

PURPOSE: To examine the fate of muscle-derived stem cells (MDSC) after injection into different host conditions and provide an insight for their mechanism of action. MATERIALS AND METHODS: MDSCs differentiated in vitro towards the endothelial lineage and transfected with lentivirus tagged with green fluorescent protein (GFP) were injected into two animal models mimicking vascular diseases: hindlimb ischemia and carotid injury models. Injected cells were tracked at the site of injection and in remote organs by harvesting the respective tissues at different time intervals and performing immunofluorescent histological analyses. Stem cell survival was quantified at the site of injection for up to 4 weeks. RESULTS: MDSCs were successfully tagged with fluorescent material GFP and showed successful implantation into the respective injection sites. These cells showed a higher affinity to implant in blood vessel walls as shown by double fluorescent co-stain with CD31. Quantification of stem cell survival showed a time-dependent decrease from day 3 to 4 weeks (survival rate normalized against day 3 was 72.0% at 1 week, 26.8% at 2 weeks and 2.4% at 4 weeks). Stem cells were also fo und in distant organs, especially the kidneys and liver, which survived up to 4 weeks. CONCLUSION: MDSCs were successfully tracked in different vascular disease models, and their fate was assessed in terms of cell survival and distribution. Better understanding of the donor cell properties, including their interaction with the host conditions and their mechanism of action, are needed to enhance cell survival and achieve improved outcomes.
Adult Stem Cells ; Animals ; Blood Vessels ; Cell Survival ; Hindlimb ; Humans ; Ischemia ; Kidney ; Lentivirus ; Liver ; Models, Animal ; Stem Cell Niche ; Stem Cells* ; Tissue Donors ; Vascular Diseases

Because of various current problems and issues which are low health insurance medical fee of National Health Insurance Corporation, extreme competition with very large general hospitals, new supply of more than of 3,000 new doctors, many medical practitioner's offices who are suffering management difficulties are increasing. In order to investigate their current overall management situations, we made this study through statistical extraction procedures with the sample population of the medical practitioners which are registered in Korean Medical Association and subsequently we made the study with 1,031 selected cases. The average number of patients is 53.6 patients per day. 44.4% of the medical practitioners' offices are working at night and legal holidays and 8.5% are working at Sunday. Average working hours is 50.1 hours per week, which greatly exceeds 40 hours per week that is regulated in the Labor Standards Act. According to the management performance analysis of those medical clinics through profit and loss statements, average total annual sales revenue in 2010 fiscal year was 444,167,867 KRW, the expenses were 314,217,081 KRW and the earnings before taxes was 129,940,786 KRW. The average net profit (earnings before taxes) of the director of the medical practitioners' offices was 122,337,868 KRW per year and 10,194,822 KRW per month. According to the study results, we have found that we need to increase doctor's bill for outpatient, and establishment and its improvement of medical service delivery systems and classification standards of medical services for first and succeeding outpatients. Considering overall results of the study, readjustment of outpatients' treatment fees and reestablishment of more efficient medical service delivery systems which require the first medical service is to be provided properly should be realized in order to improve the management performance of the medical practitioners' offices.
Commerce ; Fees and Charges ; Fees, Medical ; Holidays ; Hospitals, General ; Humans ; Insurance, Health ; Korea ; National Health Programs ; Outpatients ; Stress, Psychological ; Taxes