Background: Limited data are available on the mortality rates of patients receiving extracorporeal membrane oxygenation (ECMO) support for coronavirus disease 2019 (COVID-19). We aimed to analyze the relationship between COVID-19 and clinical outcomes for patients receiving ECMO. Methods: We retrospectively investigated patients with COVID-19 pneumonia requiring ECMO in 19 hospitals across Korea from January 1, 2020 to August 31, 2021. The primary outcome was the 90-day mortality after ECMO initiation. We performed multivariate analysis using a logistic regression model to estimate the odds ratio (OR) of 90-day mortality. Survival differences were analyzed using the Kaplan–Meier (KM) method. Results: Of 127 patients with COVID-19 pneumonia who received ECMO, 70 patients (55.1%) died within 90 days of ECMO initiation. The median age was 64 years, and 63% of patients were male. The incidence of ECMO was increased with age but was decreased after 70 years of age. However, the survival rate was decreased linearly with age. In multivariate analysis, age (OR, 1.048; 95% confidence interval [CI], 1.010–1.089; P = 0.014) and receipt of continuous renal replacement therapy (CRRT) (OR, 3.069; 95% CI, 1.312–7.180; P = 0.010) were significantly associated with an increased risk of 90-day mortality. KM curves showed significant differences in survival between groups according to age (65 years) (log-rank P = 0.021) and receipt of CRRT (log-rank P = 0.004). Conclusion Older age and receipt of CRRT were associated with higher mortality rates among patients with COVID-19 who received ECMO.

Background/Aims: We aimed to compare the effectiveness and safety of Janus kinase inhibitors (JAKi) vs. biologic disease- modifying antirheumatic drugs (bDMARD) in Korean patients with rheumatoid arthritis (RA) who had an inadequate response to conventional synthetic DMARDs. Methods: A quasi-experimental, multi-center, prospective, non-randomized study was conducted to compare response rates between JAKi and bDMARDs in patients with RA naïve to targeted therapy. An interim analysis was performed to estimate the proportion of patients achieving low disease activity (LDA) based on disease activity score (DAS)–28– erythroid sedimentation rate (ESR) (DAS28-ESR) at 24 weeks after treatment initiation and to evaluate the development of adverse events (AEs). Results: Among 506 patients enrolled from 17 institutions between April 2020 and August 2022, 346 (196 JAKi group and 150 bDMARD group) were included in the analysis. After 24 weeks of treatment, 49.0% of JAKi users and 48.7% of bDMARD users achieved LDA (p = 0.954). DAS28-ESR remission rates were also comparable between JAKi and bDMARD users (30.1% and 31.3%, respectively; p = 0.806). The frequency of AEs reported in the JAKi group was numerically higher than that in the bDMARDs group, but the frequencies of serious and severe AEs were comparable between the groups. Conclusions Our interim findings reveal JAKi have comparable effectiveness and safety to bDMARDs at 24 weeks after treatment initiation.

In this study, the Ti6Al4V specimens were fabricated using selective laser melting (SLM) method (Ti6Al4V-AS group). These specimens were performed to heat treatment at 950℃ and 550℃ using vacuum electric furnace (Ti6Al4V-HT group). The mechanical properties, metallographic shape, crystalline structure, and chemical compositions of the alloy specimens before and after heat treatment were analyzed. The Ti6Al4V-AS group showed ultimate tensile strength (UTS) and low elongation values. Acicular crystal grains were observed in metallographic image and the α'-Ti phase was dominant. After heat treatment (Ti6Al4V-HT group), the UTS was lowered and the elongation was increased. In addition, a lamellar structure in which columnar crystal grains are arranged was observed, α+β-Ti phase was formed, and crystallinity increased. As a result of analyzing the chemical composition, the Ti6Al4V-AS specimen contained a higher carbon content than the Ti6Al4V-HT specimen. This high carbon content could be related to the formation of α'-phase, high strength and low elongation of the Ti6Al4V-AS specimen. Ti6Al4V-HT specimen showed that the overall carbon content was low, but the carbon content was locally high in the α-Ti phase region. Therefore, it is necessary to control effectively the incorporation of carbon gas in the production of Ti6Al4V specimens using SLM.

Background: Dipeptidyl peptidase-4 (DPP-4) inhibitor has been reported to have kidney-protective benefits. To elucidate how antidiabetic agents prevent diabetic kidney disease progression, it is important to investigate their effect on the kidney environment in type 2 diabetes mellitus (DM) patients. Herein, we investigated the expression pattern of urinary exosome-derived microRNA (miRNA) in patients taking a combination of DPP-4 inhibitor and metformin (DPP-4 inhibitor group) and compared them with patients taking a combination of sulfonylurea and metformin (sulfonylurea group). Methods: This was a prospective study involving 57 patients with type 2 DM (DPP-4 inhibitor group, n = 34; sulfonylurea group, n = 23) and healthy volunteers (n = 7). We measured urinary exosomal miRNA using the NanoString nCounter miRNA array (NanoString Technologies) across the three groups (n = 4 per each group) and validated findings using real-time polymerase chain reaction. Results: Twenty-one differentially expressed candidate miRNAs were identified, and six (let-7c-5p, miR-23a-3p, miR-26a-3p, miR-30d, miR-205, and miR-200a) were selected for validation. Validation showed no significant difference in miRNA expression between the DPP-4 inhibitor and sulfonylurea groups. Only miR-23a-3p was significantly overexpressed in the diabetes group compared with the control group (DPP-4 inhibitor vs. control, p = 0.01; sulfonylurea vs. control, p = 0.007). This trend was consistent even after adjusting for age, sex, and body mass index. Conclusion There was no significant difference in urine exosome miRNA expression between diabetic participants taking DPP-4 inhibitor and those taking sulfonylurea. The miR-23a levels were higher in diabetic participants than in nondiabetic controls.

Background/Aims: Chest pain in patients with obstructive coronary artery disease (OCAD) is affected by several social factors. The gender-based differences in chest pain among Koreans have yet to be investigated. Methods: The study consecutively enrolled 1,549 patients (male/female, 514/1,035; 61 ± 11 years old) with suspected angina. The predictive factors for OCAD based on gender were evaluated. Results: Men experienced more squeezing type pain on the left side of chest, while women demonstrated more dull quality pain in the retrosternal and epigastric area. After adjustment for risk factors, pain in the retrosternal area (odds ratio [OR], 1.491; 95% confidence interval [CI], 1.178 to 1.887) and aggravation by exercise (OR, 2.235; 95% CI, 1.745 to 2.861) were positively associated with OCAD. In men, shorter duration (OR, 1.581; 95% CI, 1.086 to 2.303) and dyspnea (OR, 1.610; 95% CI, 1.040 to 2.490) increased the probability for OCAD, while left-sided chest pain suggested a low probability for OCAD (OR, 0.590; 95% CI, 0.388 to 0.897). In women, aggravation by emotional stress (OR, 0.348; 95% CI, 0.162 to 0.746) and dizziness (OR, 0.457; 95% CI, 0.246 to 0.849) decreased the probability for OCAD. Conclusions This is the first study to focus on gender differences in chest pain among Koreans with angina. Symptoms with high probability for OCAD were different between sexes. Our findings suggest that patient’s medical history in pretest assessment for OCAD should be individualized considering gender.

PURPOSE: The information committee of the Korean Society for Metabolic and Bariatric Surgery (KSMBS) performed the nationwide survey of bariatric and metabolic operations to report IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) worldwide survey annually. This study aimed to report the trends of bariatric and metabolic surgery in Korea in 2014–2017. MATERIALS AND METHODS: We analyzed the accumulated nationwide survey data conducted for annual ISFO survey from 2014 to 2017. Trends such as the number of operations by hospital type and the number of operations by surgical method were analyzed. RESULTS: The number of operations has decreased sharply in 2015 comparing to 2014 (913⇒550). The number of operations performed in private hospitals dropped sharply from 529 to 250, 198, and 103 cases. The number of revisional surgeries increased to 223 in 2015. The primary surgery number fell from 757 in 2014 to 327 in 2015. In primary surgery, sleeve gastrectomy was gradually increased from 2014 to 143 (18.9%), 105 (32.1%), 167 (47.2%) and 200 (56.3%) and became the most frequently performed surgery. On the other hand, the incidence of adjustable gastric band decreased gradually from 439 (58.0%) to 117 (35.8%), 112 (31.6%) and 59 (16.6%). CONCLUSION: The overall number of obesity metabolic operations has decreased since 2014, especially the number of adjustable gastric band, and the number of operations in private hospitals declined sharply. On the other hand, the number of operations in university hospitals did not change much, and the number of sleeve gastrectomy increased.
Bariatric Surgery ; Gastrectomy ; Hand ; Hospitals, Private ; Hospitals, University ; Incidence ; Korea ; Methods ; Obesity

In the era of government 3.0, the availability of open government-owned public data and data sharing with the private sector are important. We surveyed the status of public data openness in the healthcare domain and of compliance with the standard open data format based on the “5 stars of linked data” model. We examined healthcare data on the Open Data Portal (https://www.data.go.kr). We also surveyed data on the websites of the public institutions and state administrative agencies that provided healthcare data on the Portal. In terms of data on the Portal, all public institutions except the National Medical Center, the Korea Institute of Science and Technology Information, and the Korea Environment Corporation were found to have provided data in the 3-stars format corresponding to the Public Data Open Standard Maintenance Guide. All data provided by state administrative agencies met the 3-stars format. Only 2 institutions (the Health Insurance Review & Assessment Service and the Korea Health Industry Development Institute) released data in the 3-stars format on their websites. Among the major state administrative agencies providing data on the Portal, none released data in the 3-stars format on their websites. Government-owned data should be provided in a standard format both on the Open Data Portal and on data-holders' websites to facilitate communication and collaboration. Considering the huge potential of linked healthcare data from a single national health insurance system, providing open data in compliance with the standard open format will promote the opening and sharing of public data.
Compliance* ; Cooperative Behavior ; Delivery of Health Care* ; Information Dissemination ; Information Storage and Retrieval ; Insurance, Health ; Korea* ; National Health Programs ; Private Sector ; Public Sector ; Vital Statistics

PURPOSE: Alpha1 (alpha1)-adrenoceptor antagonists are widely used to treat lower urinary tract symptoms. These drugs not only act on peripheral tissues, but also cross the blood-brain barrier and affect the central nervous system. Therefore, alpha1-adrenoceptor antagonists may enhance brain functions. In the present study, we investigated the effects of tamsulosin, an alpha1-adrenoceptor antagonist, on short-term memory, as well as spatial learning and memory, in rats. METHODS: The step-down avoidance test was used to evaluate short-term memory, and an eight-arm radial maze test was used to evaluate spatial learning and memory. TUNEL (terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling) staining was performed in order to evaluate the effect of tamsulosin on apoptosis in the hippocampal dentate gyrus. Patch clamp recordings were used to evaluate the effect of tamsulosin on ionotropic glutamate receptors, such as N-methyl-D-aspartate (NMDA), amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA), and kainate receptors, in hippocampal CA1 neurons. RESULTS: Tamsulosin treatment improved short-term memory, as well as spatial learning and memory, without altering apoptosis. The amplitudes of NMDA-induced ion currents were dose-dependently increased by tamsulosin. However, the amplitudes of AMPA- and kainate-induced ion currents were not affected by tamsulosin. CONCLUSIONS: Tamsulosin enhanced memory function by activating NMDA receptor-mediated ion currents in the hippocampus without initiating apoptosis. The present study suggests the possibility of using tamsulosin to enhance memory under normal conditions, in addition to its use in treating overactive bladder.
Animals ; Apoptosis ; Blood-Brain Barrier ; Brain ; Central Nervous System ; Dentate Gyrus ; Hippocampus* ; In Situ Nick-End Labeling ; Learning ; Lower Urinary Tract Symptoms ; Memory* ; Memory, Short-Term ; N-Methylaspartate ; Neurons ; Patch-Clamp Techniques ; Rats* ; Receptors, Ionotropic Glutamate ; Receptors, Kainic Acid ; Receptors, N-Methyl-D-Aspartate ; Urinary Bladder, Overactive

Interdigitating dendritic cell sarcoma (IDCS) is a very rare disease around the world and its prognosis is known to be aggressive. This reports a case diagnosed as IDCS of the axillary region treated in Soonchunhyang University Hospital. A 57-year-old female visited Soonchunhyang University Hospital with a left axillary mass. The mass was hard and fixed. Computed tomography observed a 7 cm lymph node at the left axilla, and core biopsy suspected sarcoma. In another study, there was no specific finding except the axillary lesion. Left axillary lymph node dissection (level I, II) was conducted and the pathologic report finally showed IDCS. The patient was treated with only radiotherapy and followed up without recurrence for 13 months up to now. IDCS is a very rare sarcoma that is hard to diagnose and progresses fast. Thus, treatment is very difficult. Proper treatment can be better established after more experiences.
Axilla ; Biopsy ; Dendritic Cell Sarcoma, Interdigitating ; Dendritic Cells ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Middle Aged ; Polyenes ; Prognosis ; Rare Diseases ; Recurrence ; Sarcoma

PURPOSE: Forkhead box protein 3 (FOXP3)+T cells are the major regulatory T cells controlling all aspects of the immune response. Transforming growth factor-beta (TGF-beta) is a suppressive cytokine which mediates the suppressive action of FOXP3+T cells. The aim of this study was to investigate the role of FOXP3+T cells, TGF-beta in colonic mucosa of children with Crohn's disease (CD). METHODS: Colonic mucosal biopsies were obtained from 10 children with CD (12~15 years of age) and 11 control (8~15 years of age). Frequencies of FOXP3+T, CD4+T cells and TGF-beta1 expression were examined in the lamina propria (LP) and lymphoid aggregates or follicles (LA/F) by immunohistochemistry, and later evaluated by association with disease activity. RESULTS: In the LP of CD group, frequencies of FOXP3+T, CD4+T cells, proportion of FOXP3/CD4+T cells and TGF-beta1 expression significantly increased compared to the control. In the LA/F of CD group, frequency of FOXP3+T cells, proportion of FOXP3/CD4+T cells and TGF-beta1 expression significantly increased compared to the control (p<0.05). CD4+T cells also increased compared to the control, but this finding was not significant. In the LP and LA/F of CD group, frequency of FOXP3+T cells exhibited positive correlation with CD4+T cells (p<0.05). In the LP and LA/F of CD group, TGF-beta1 expression had positive correlation with CRP, Pediatric Crohn's Disease Activity Index, and negative correlation with hematocrit and albumin (p<0.05). CONCLUSION: Increased frequency of FOXP3+T cells and TGF-beta1 expression in colonic mucosa of CD can be interpreted as a compensatory increase towards achieving down-regulation of immune responses.
Biopsy ; Child ; Colon ; Crohn Disease ; Down-Regulation ; Hematocrit ; Humans ; Immunohistochemistry ; Mucous Membrane ; T-Lymphocytes ; T-Lymphocytes, Regulatory ; Transforming Growth Factor beta ; Transforming Growth Factor beta1