Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

BACKGROUND/OBJECTIVES: Although adherence to a higher diet quality may help prevent cognitive decline in older adults, literature for this in a Korean population is limited. Thus, the aim of this study was to examine the association between diet quality indices and the risk of mild cognitive impairment (MCI) in Korean older adults. SUBJECTS/METHODS: This cross-sectional study included 806 community-dwelling people aged 60 yrs and over in Korea. Diet quality was assessed via the revised Recommended Food Score (RFS) and alternate Mediterranean Diet Score (aMDS). Cognitive function was measured using a Korean version of the Mini-Mental State Examination (MMSE-KC).Associations between diet quality indices and MMSE-KC score were assessed with a general linear model after adjusting for covariates. Logistic regression was used to determine the association between diet quality indices and the risk of MCI. RESULTS: The prevalence of MCI was 35.3%. There were no significant trends between MMSE-KC scores and RFS and aMDS after adjusting for age, gender, education, exercise, living status, social activity, and alcohol drinking. Among total subjects, RFS was inversely associated with the risk of MCI after adjusting for covariates (Q5 vs. Q1; odds ratio [OR], 0.49; 95% confidence interval [CI], 0.28–0.83). Among total subjects and men, aMDS was inversely related to the risk of MCI after adjusting for covariates (Q5 vs. Q1; OR, 0.51; 95% CI, 0.29–0.89 for total subjects; Q5 vs. Q1; OR, 0.36; 95% CI, 0.15–0.83 for men). CONCLUSIONS Our results demonstrate that high diet quality evaluated by RFS and aMDS is inversely associated with the risk of MCI. Thus, high quality diet may reduce or retard cognitive decline in the old population. Longitudinal studies are needed to determine the causal relationship between diet quality and the risk of MCI in the elderly.

Purpose: Acute promyelocytic leukemia (APL) is a rare disease in children and there are some different characteristics between children and adult. We aimed to evaluate incidence, clinical characteristics and treatment outcomes of pediatric APL in Korea. Materials and Methods: Seventy-nine pediatric APL patients diagnosed from January 2009 to December 2016 in 16 tertiary medical centers in Korea were reviewed retrospectively. Results: Of 801 acute myeloid leukemia children, 79 (9.9%) were diagnosed with APL. The median age at diagnosis was 10.6 years (range, 1.3 to 18.0). Male and female ratio was 1:0.93. Thirty patients (38.0%) had white blood cell (WBC) count greater than 10×109/L at diagnosis. All patients received induction therapy consisting of all-trans retinoic acid and chemotherapy. Five patients (6.6%) died during induction chemotherapy and 66 patients (86.8%) achieved complete remission (CR) after induction chemotherapy. The causes of death were three intracranial hemorrhage, one cerebral infarction, and one sepsis. Five patients (7.1%) suffered a relapse during or after maintenance chemotherapy. The estimated 4-year event-free survival and overall survival (OS) rates were 82.1%±4.4%, 89.7%±5.1%, respectively. The 4-year OS was significantly higher in patients with initial WBC < 10×109/L than in those with initial WBC ≥ 10×109/L (p=0.020). Conclusion This study showed that the CR rates and survival outcomes in Korean pediatric APL patients were relatively good. The initial WBC count was the most important prognostic factor and most causes of death were related to serious bleeding in the early stage of treatment.

Background/Aims: Renal ischemia followed by reperfusion (I/R) is a leading cause of acute kidney injury (AKI), which is closely associated with high morbidity and mortality. Studies have shown that induced pluripotent stem cell (iPSC)-derived mesenchymal stem cells (iMSCs) exert powerful therapeutic effects in renal ischemia. However, the efficacy of iMSC-derived exosomes (iExo) on I/R injuries remains largely unknown. Methods: Human iPSCs were differentiated into iMSCs using a modified one-step method. Ultrafiltration, combined with purification, was used to isolate iExo from iMSCs. iExo was administered following I/R injury in a mouse model. The effect of iExo on I/R injury was assessed through changes in renal function, histology, and expression of oxidative stress, inflammation, and apoptosis markers. Further, we evaluated its association with the extracellular signal-regulated kinase (ERK) 1/2 signaling pathway. Results: Mice subjected to I/R injury exhibited typical AKI patterns; serum creatinine level, tubular necrosis, apoptosis, inflammatory cytokine production, and oxidative stress were markedly increased compared to sham mice. However, treatment with iExo attenuated these changes, significantly improving renal function and tissue damage, similar to the renoprotective effects of iMSCs on I/R injury. Significant induction of activated ERK 1/2 signaling molecules was observed in mice treated with iExo compared to those in the I/R injury group. Conclusions The present study demonstrates that iExo administration ameliorated renal damage following I/R, suggesting that iMSC-derived exosomes may provide a novel therapeutic approach for AKI treatment.

The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) first was published in 2002, and has been revised four times, in 2006, 2012, 2017, and 2021. In this review, we compared recommendations from the recently revised KMAP-DD 2021 to four global clinical practice guidelines (CPGs) for depression published after 2010. The recommendations from the KMAP-DD 2021 were similar to those from other CPGs, although there were some differences. The KMAP-DD 2021 reflected social culture and the healthcare system in Korea and recent evidence about pharmacotherapy for depression, as did other recently published evidence-based guidelines. Despite some intrinsic limitations as an expert consensus-based guideline, the KMAP-DD 2021 can be helpful for Korean psychiatrists making decisions in clinical settings by complementing previously published evidence-based guidelines, especially for some clinical situations lacking evidence from rigorously designed clinical trials.

Purpose: This study investigated the association of insulin, metformin, and statin use with survival and whether the association was modified by the hormone receptor status of the tumor in patients with breast cancer. Materials and Methods: We studied 7,452 patients who had undergone surgery for breast cancer at Seoul National University Hospital from 2008 to 2015 using the nationwide claims database. Exposure was defined as a recorded prescription of each drug within 12 months before the diagnosis of breast cancer. Results: Patients with prior insulin or statin use were more likely to be older than 50 years at diagnosis and had a higher comorbidity index than those without it (p < 0.01 for both). The hazard ratio (HR) for death with insulin use was 5.7 (p < 0.01), and the effect was attenuated with both insulin and metformin exposure with an HR of 1.2 (p=0.60). In the subgroup analyses, a heightened risk of death with insulin was further prominent with an HR of 17.9 (p < 0.01) and was offset by co-administration of metformin with an HR of 1.3 (p=0.67) in patients with estrogen receptor (ER)–negative breast cancer. Statin use was associated with increased overall mortality only in patients with ER-positive breast cancer with HR for death of 1.5 (p=0.05). Conclusion Insulin or statin use before the diagnosis of breast cancer was associated with an increase in all-cause mortality. Subsequent analyses suggested that metformin or statin use may have been protective in patients with ER-negative disease, which warrants further studies.

Objective: In the 19 years since the Korean College of Neuropsychopharmacology and the Korean Society for Affective Disorders developed the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2002, four revisions have been conducted. Methods: To increase survey efficiency in this revision, to cover the general clinical practice, and to compare the results with previous KMAP-DD series, the overall structure of the questionnaire was maintained. The six sections of the questionnaire were as follows: 1) pharmacological treatment strategies for major depressive disorder (MDD) with/without psychotic features; 2) pharmacological treatment strategies for persistent depressive disorder and other depressive disorder subtypes; 3) consensus for treatment-resistant depression; 4) the choice of an antidepressant in the context of safety, adverse effects, and comorbid physical illnesses; 5) treatment strategies for special populations (children/adolescents, elderly, and women); and 6) non-pharmacological biological therapies. Recommended first-, second-, and third-line strategies were derived statistically. Results: There has been little change in the four years since KMAP-DD 2017 due to the lack of newly introduced drug or treatment strategies. However, shortened waiting time between the initial and subsequent treatments, increased preference for atypical antipsychotics (AAPs), especially aripiprazole, and combination strategies with AAPs yield an active and somewhat aggressive treatment trend in Korea. Conclusion We expect KMAP-DD to provide clinicians with useful information about the specific strategies and medications appropriate for treating patients with MDD by bridging the gap between clinical real practice and the evidence-based world.

Objectives: The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was made to update new researches and data. This study focused on non-pharmacological biological treatments. Methods: Ninety-seven psychiatrists with extensive clinical experience in the non-pharmacological biological treatment of depressive disorder were primary selected and a questionnaire was sent to each of them by mail, 65 of the 97 replied. Results: Electroconvulsive therapy (ECT) was recommended as an initial strategy for major depressive disorder, severe depressive disorder with/without psychotic features with urgent suicidal risk, or a severe depressive episode with psychotic features in pregnant patients, for non-responders on pharmacotherapy for a moderate depressive episode, and as a second strategy for non-responders on antidepressant monotherapy or combination therapy combined with physical illness. For pregnant women with a severe episode of major depressive disorder, repetitive transcranial magnetic stimulation (rTMS) was preferred as a first-line strategy, and as a second strategy for non-responders on combined antipsychotic and antidepressant therapy and non-responders with comorbidity and physical illness. Complementary or novel treatment was not recommended as the first-line treatment strategy for depressive disorder, but transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), light therapy, and omega-3 fatty acid nutritional therapy were second-line treatment strategies. Conclusion ECT and rTMS are initial strategies in specific clinical situations. Preferences for complementary or novel treatments such as tDCS, light therapy, and omega-3 fatty acid nutritional therapy have increased gradually, but in practice, their usages are still limited.

Objectives: To revise Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAPDD 2017) guidelines by revising antidepressant choices based on their safety, adverse effects, comorbid physical illnesses, and the clinical definition of treatment-resistant depression (TRD). Methods: A 33-item questionnaire comprised of six parts was developed. A 65-expert consensus (65/97, 67.0%) was obtained on pharmacological treatment strategies regarding antidepressant choice with respect to safety, adverse effects, and comorbid physical illnesses. Multiple response sets were subjected to statistical analysis. Results: The results obtained showed that first-line pharmacotherapeutic strategies based on various clinical considerations were as follows: mirtazapine (for patients with increased suicidality, Gastrointestinal discomfort, and insomnia), bupropion (for patients with orthostatic hypotension, history of a safety accident, serotonin syndrome, sedation, sexual dysfunction, and weight gain), and escitalopram (for patients with anticholinergic side effects). For patients exhibiting comorbid conditions, duloxetine was the first line pharmacotherapeutic strategy for chronic pain, escitalopram was the first-line pharmacotherapeutic strategy for diabetes, hypertension, liver disease, Parkinson’s disease, renal disease, epilepsy, and thyroid disease, and sertraline was a first-line pharmacotherapeutic strategy for arrhythmia and cardiovascular disease. Conclusion Pharmacological treatment strategy of KMAP-DD 2021 is similar to that of KMAPDD 2017. Additional study is required to determine antidepressant choices for TRD and cancer patients with depression.

Objectives: An expert consensus guideline for the treatment of depressive disorder, the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD), was first established in 2002 and updated in 2017. To provide an up-to-date treatment guideline, KMAP-DD 2021 was recently completed. This study was undertaken to provide a guideline for the treatment of depressive disorder in a selected population that included females and elderly. Methods: The survey conducted consisted of 7 questionnaires for each population, females and elderly, with depressive disorder. A total of 65 of 97 experienced psychiatrists answered the survey. Results: For the treatment of premenstrual dysphoric disorder, the selective serotonin reuptake inhibitors, venlafaxine, and desvenlafaxine were recommended as first-line therapies. For major depressive disorder (MDD) during pregnancy, antidepressant (AD) monotherapy was recommended as a first-line therapy for mild to moderate and severe depression, and combined electroconvulsive therapy and AD with atypical antipsychotics (AAP) were recommended as a first-line therapy for severe depression with psychotic features. AD plus AAP was generally recommended for post-partum depression. In elderly with depression, AD monotherapy was recommended as the treatment of choice for mild to moderate episodes, and AD monotherapy and AD plus AAP were recommended as a first-line therapy for severe depression without psychotic features. Lastly, AD plus AAP was chosen as the treatment of choice for psychotic depression. Conclusion Present study provides an updated algorithm for the treatment of females and elderly with depressive disorders. This algorithm provides a practical aid to clinicians for the treatment of females and elderly with MDD.