Due to technological advances and the establishment of evidence-based medicine, radiological examinations are playing a crucial role in modern medicine, as a result of which they have been steadily increasing, and the rate of increase has intensified in the 2000s. Although this is a global phenomenon, the increase of radiological examinations in Korea is also high due to the introduction of the National Health Insurance Coverage Expansion Policy, so-called Moon Jae-in Care, for ultrasonography and magnetic resonance imaging. For accurate and rapid diagnosis of diseases, it is necessary for doctors to order appropriate radiological studies. However, the increase in radiological examination has created many problems, such as increased medical costs, decreased diagnostic accuracy due to radiologist burnout, and increased patient exposure to radiation. To reduce unnecessary imaging studies, a number of measures could be deployed including the development of clinical guidelines to select appropriate radiological examinations for each clinical situation.
Diagnosis ; Evidence-Based Medicine ; History, Modern 1601- ; Humans ; Insurance, Health ; Korea ; Magnetic Resonance Imaging ; Moon ; National Health Programs ; Ultrasonography

Percutaneous pulmonary valve implantation (PPVI) is recognized as a feasible and low risk alternative to surgery to treat dysfunctional right ventricular outflow tract (RVOT) in usually pluri-operated patients. Evolving technology allowed to develop different kind of prosthesis and to go from an initial treatment exclusively of stenotic conduit to an actual approach extended also to wide native RVOT. The Melody transcatheter pulmonary valve (TPV) and the Edwards Sapien valve are nowadays the most commonly implanted prostheses. However, other devices have been developed to treat large RVOT (i.e., the Venus p-valve, the Medtronic Harmony TPV, the Alterra Adaptive Prestent, and the Pulsta valve). Indications for PPVI are the same as for surgical interventions on pulmonary valve, with limits related to the maximum diameter of the available percutaneous prosthesis. Therefore, an accurate preoperative evaluation is of paramount importance to select patients who could benefit from this procedure. The overall periprocedural mortality incidence is around 1.4%, while freedom from RVOT reintervention ranges from 100% at 4 months to 70% at 70 months, according to the different published studies.
Freedom ; Heart Defects, Congenital ; Humans ; Incidence ; Mortality ; Prostheses and Implants ; Pulmonary Valve ; Venus

Blood Pressure ; Body Mass Index ; Cervix Uteri ; Elasticity ; Elasticity Imaging Techniques ; Female ; Hardness ; Heart Rate ; Humans ; Jupiter ; Labor Presentation ; Pregnancy ; Pregnant Women ; Premature Birth ; Reproducibility of Results ; Uterine Artery

After the announcement of Moon Jae-in Government's plan (Moon's Care) for Benefit Expansion in National Health Insurance in August 2017, it is necessary to monitor the effects of the policy, especially household out-of-pocket payments (OOP). This paper aims to observe the current status and trend of OOP in Korea. Current health expenditure (CHE) was 144.4 trillion won in 2018, which accounts for 8.1% of gross domestic product (GDP) increased 9.7% from the previous year. Although GDP's share of CHE has been close to the average of the Organization for Economic Cooperation and Development (OECD) countries, the public fund's share was 59.8% of the total in 2018, which was lower than the OECD average of 73.5%. OOP's share was 32.9% in 2018, which decreased from 37.4% in 2008. The share of OOP of non-covered services was 20.0% in 2018, which decreased from 22.9% in 2008. The share of cost-sharing with third-party payers was 12.9% in 2018, which decreased from 14.5% in 2008. The OOP of non-covered services was significantly decreased in hospital and inpatient curative care, but the OOP of non-covered services was significantly increased in the medical clinic. The effect of Moon's Care was not showed in OOP through the results of 2017 and 2018, but further monitoring is needed because the Moon's Care is progressing and the observational period is short.
Family Characteristics ; Gross Domestic Product ; Health Expenditures ; Humans ; Inpatients ; Insurance, Health, Reimbursement ; Korea ; Moon ; National Health Programs ; Organisation for Economic Co-Operation and Development

BACKGROUND AND PURPOSE: The most-common initial manifestation of Miller Fisher syndrome (MFS) is diplopia due to acute ophthalmoplegia. However, few studies have focused on ocular motility findings in MFS. This study aimed to determine the pattern of extraocular muscle (EOM) paresis in MFS patients. METHODS: We consecutively recruited MFS patients who presented with ophthalmoplegia between 2010 and 2015. The involved EOMs and the strabismus pattern in the primary position were analyzed. Antecedent infections, other involved cranial nerves, and laboratory findings were also reviewed. We compared the characteristics of the patients according to the severity of ophthalmoplegia between complete ophthalmoplegia (CO) and incomplete ophthalmoplegia (IO). RESULTS: Twenty-five patients (15 males and 10 females) with bilateral ophthalmoplegia were included in the study. The most-involved and last-to-recover EOM was the lateral rectus muscle. CO and IO were observed in 11 and 14 patients, respectively. The patients were aged 59.0±18.4 years (mean±SD) in the CO group and 24.9±7.4 years in the IO group (p<0.01), and comprised 63.6% and 21.4% females, respectively (p=0.049). Elevated cerebrospinal fluid protein was identified in 60.0% of patients with CO and 7.7% of patients with IO (p=0.019) for a mean follow-up time from the initial symptom onset of 3.7 days. CONCLUSIONS: The lateral rectus muscle is the most-involved and last-to-recover EOM in ophthalmoplegia. The CO patients were much older and were more likely to be female and have an elevation of cerebrospinal fluid protein than the IO patients.
Cerebrospinal Fluid ; Cranial Nerves ; Diplopia ; Female ; Follow-Up Studies ; Guillain-Barre Syndrome ; Humans ; Jupiter ; Male ; Miller Fisher Syndrome ; Ophthalmoplegia ; Paresis ; Strabismus

This study examines how Choe Han-gi (崔漢綺, 1803–1879) developed his medical discourse which integrated the concepts of traditional Chinese medicine with modern Western anatomy, based on the philosophy of Seo Gyeong-deok (徐敬德, 1489–1546), a scholar of the Neo-Confucianism of Joseon (1392–1910). Seo emphasized gi (氣, C. qi, vital, material force) rather than yi (理, C. li, the principle of things) as a way of understanding the world. Since Choe's early academic interests pertained to Neo-Confucianism, it is reasonable to examine his philosophy in this context. Similar to Seo, Choe assumed that the most essential component of the world was the intrinsic and mysterious gi. Although Seo spoke of gi as a damil cheongheo ji gi (湛一淸虛之氣, the gi which is profound, uniform, clear, invisible, and empty), Choe preferred to use the word singi (神氣, C. shenqi, the intrinsic, invisible, and mysterious gi). He believed that the earth, moon, and stars operated through the action of singi and that all creatures could only exist by relying on it. Singi was the most important premise in Choe's medical discourse, a fact demonstrating that although he could be very critical of traditional Chinese medicine, his perspective was part of that tradition. He believed that singi integrated and operated the entire human body and that it perceived external objects. He also emphasized the role of hyeongjil (形質, C. xingzhi, a visible object with a form and quality; here it means all human bodies). This was the medium through which singi could appear in reality. Choe thought that singi could not reveal itself in reality without hyeongjil, and that hyeongjil became a dead thing without singi. His perception of the role of hyeongjil was expressed in his interest in modern Western anatomy, an interest that complemented his focus on singi. In light of his understanding of the singi-hyeongjil relationship, Choe criticized both modern Western anatomy and traditional Chinese medicine. He thought that modern Western anatomy lacked awareness of singi and that traditional Chinese medicine lacked accurate knowledge of human anatomy. Although he was not completely sympathetic toward any forms of medicine, he was open to ideas from both Western and Chinese medicine. Choe could not accept Western anatomy as fully as Japanese intellectuals did. The study of anatomy in Japan had developed in relation to the idea of Ancient Learning (古學, C. guxue), which denied such theories of systematic correspondence as Yin and Yang and the Five Elements (陰陽 五行, C. yinyang wuxing) and tended to focus on the action of hyeongjil itself. Because Choe accepted modern Western anatomy without accepting Ancient Learning, his perspective was unique in the history of East Asian anatomy. From a medical history perspective, how does Choi Han-gi's medical discourse distinguish itself from other medical discourses, and what are its characteristics? In addition to other explanations, focusing on the political imagination associated with medicine can help illuminate the differences between the medical discourse of Choe and those of others. Discussion of medicine and the human body was tied to political thought, manifesting the political imagination of the society in which that discussion took place. The development of Western and Japanese anatomy reflected a vertical and hierarchical political order, exemplified by the belief that the brain was the center of the body. However, Choe doubted that organs like the brain or heart dominated the body. In his view, the singi ruled the body; it was not a specific organ, and it was equally inherent in all people. His political thought also emphasized the horizontal and equal order among people. His view of singi simultaneously influenced both his perspective on medicine and his perspective on society. Choe Han-gi's belief in this horizontal and equal political order was inherent in his singi-centered medical discourse.
Asian Continental Ancestry Group ; Brain ; Clothing ; Complement System Proteins ; Heart ; Human Body ; Humans ; Imagination ; Japan ; Learning ; Medicine, Chinese Traditional ; Moon ; Philosophy ; Qi

The neuronal activity-dependent change in the manner in which light is absorbed or scattered in brain tissue is called the intrinsic optical signal (IOS), and provides label-free, minimally invasive, and high spatial (~100 µm) resolution imaging for visualizing neuronal activity patterns. IOS imaging in isolated brain slices measured at an infrared wavelength (>700 nm) has recently been attributed to the changes in light scattering and transmittance due to aquaporin-4 (AQP4)-dependent astrocytic swelling. The complexity of functional interactions between neurons and astrocytes, however, has prevented the elucidation of the series of molecular mechanisms leading to the generation of IOS. Here, we pharmacologically dissected the IOS in the acutely prepared brain slices of the stratum radiatum of the hippocampus, induced by 1 s/20 Hz electrical stimulation of Schaffer-collateral pathway with simultaneous measurement of the activity of the neuronal population by field potential recordings. We found that 55% of IOSs peak upon stimulation and originate from postsynaptic AMPA and NMDA receptors. The remaining originated from presynaptic action potentials and vesicle fusion. Mechanistically, the elevated extracellular glutamate and K⁺ during synaptic transmission were taken up by astrocytes via a glutamate transporter and quinine-sensitive K2P channel, followed by an influx of water via AQP-4. We also found that the decay of IOS is mediated by the DCPIB- and NPPB-sensitive anion channels in astrocytes. Altogether, our results demonstrate that the functional coupling between synaptic activity and astrocytic transient volume change during excitatory synaptic transmission is the major source of IOS.
Action Potentials ; alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid ; Amino Acid Transport System X-AG ; Astrocytes ; Brain ; Electric Stimulation ; Glutamic Acid ; Hippocampus ; Jupiter ; Neurons ; Receptors, N-Methyl-D-Aspartate ; Synaptic Transmission ; Water

PURPOSE: The purpose of this study is to assess the accuracy of three intraoral scanners along the complete dental arch and evaluate the feasibility of the assessment methodology for further in vivo analysis.MATERIALS AND METHODS: A specific measurement pattern was fabricated and measured using a coordinate measuring machine for the assessment of control distances and angles. Afterwards, the pattern was placed and fixed in replica of an upper jaw for their subsequent scans (10 times) using 3 intraoral scanners, namely iTero Element1, Trios 3, and True Definition. 4 reference distances and 5 angles were measured and compared with the controls. Trueness and precision were assessed for each IOS: trueness, as the deviation of the measures from the control ones, while precision, as the dispersion of measurements in each reference parameter. These measurements were carried out using software for analyzing 3-dimensional data. Data analysis software was used for statistical and measurements analysis (α=.05).RESULTS: Significant differences (P<.05) were found depending on the intraoral scanner used. Best trueness values were achieved with iTero Element1 (mean from 10 ± 7 µm to 91 ± 63 µm) while the worst values were obtained with Trios3 (mean from 42 ± 23 µm to 174 ± 77 µm). Trueness analysis in angle measurements, as well as precision analysis, did not show conclusive results.CONCLUSION: iTero Element1 was more accurate than the current versions of Trios3 and True Definition. Importantly, the proposed methodology is considered reliable for analyzing accuracy in any dental arch length and valid for assessing both trueness and precision in an in vivo study.
Dental Arch ; Jaw ; Jupiter ; Methods ; Pilot Projects ; Statistics as Topic

PURPOSE: Comparing the accuracy of casts produced from digital workflow to that of casts produced from conventional techniques. MATERIALS AND METHODS: Whole arch alginate (ALG) and polyvinyl siloxane (PVS) impressions were taken with stock trays and custom trays, respectively. The ALG impressions were poured with type III dental stone, while the PVS impressions were poured with type IV dental stone. For the digital workflow, IOS impressions were taken and physical casts were produced by 3D printing. In addition, 3D printed casts were produced from images obtained from a laboratory scanner (LS). For each technique, a total of 10 casts were produced. The accuracies of the whole arch and separated teeth were virtually quantified. RESULTS: Whole arch cast accuracy was more superior for PVS followed by LS, ALG, and IOS. The PVS and ALG groups were inferior in the areas more susceptible to impression material distortion, such as fossae and undercut regions. The LS casts appeared to have generalized errors of minor magnitude influencing primarily the posterior teeth. The IOS casts were considerably more affected at the posterior region. On the contrary, the IOS and LS casts were more superior for single tooth accuracy followed by PVS and ALG. CONCLUSION: For whole arch accuracy, casts produced from IOS were inferior to those produced from PVS and ALG. The inferior outcome of IOS appears to be related to the span of scanning. For single tooth accuracy, IOS showed superior accuracy compared to conventional impressions.
Jupiter ; Polyvinyls ; Printing, Three-Dimensional ; Siloxanes ; Tooth

PURPOSE: The newest technologies for digital implant impression (DII) taking are developing rapidly and showing acceptable clinical results. However, scientific literature is lacking data from clinical studies about the accuracy of DII. The aim of this study was to compare digital and conventional dental implant impressions (CII) in a clinical environment. MATERIALS AND METHODS: Twenty-four fixed zirconia restorations supported by 2 implants were fabricated using conventional open-tray impression technique with splinted transfers (CII group) and scan with Trios 3 IOS (3Shape) (DII group). After multiple verification procedures, master models were scanned using laboratory scanner D800 (3Shape). 3D models from conventional and digital workflow were imported to reverse engineering software and superimposed with high resolution 3D CAD models of scan bodies. Distance between center points, angulation, rotation, vertical shift, and surface mismatch of the scan bodies were measured and compared between conventional and digital impressions. RESULTS: Statistically significant differences were found for: a) inter-implant distance, b) rotation, c) vertical shift, and d) surface mismatch differences, comparing DII and CII groups for mesial and dist al implant scan bodies (P≤.05). CONCLUSION: Recorded linear differences between digital and conventional impressions were of limited clinical significance with two implant-supported restorations.
Clinical Study ; Dental Implants ; Denture, Partial, Fixed ; Jupiter ; Splints