Background: This study examines integrating physical and mental healthcare for disadvantaged persons with type 2 diabetes mellitus and mild-to-moderate depression in the community, using a mobile application within a public-private-academic partnership. Methods: The Korean Diabetes Association has developed a mobile application combining behavioral activation for psychological well-being and diabetes self-management, with conventional medical therapy. Participants were randomly assigned to receive the application with usual care or only usual care. Primary outcomes measured changes in psychological status and diabetes selfmanagement through questionnaires at week 12 from the baseline. Secondary outcomes assessed glycemic and lipid control, with psychological assessments at week 16. Results: Thirty-nine of 73 participants completed the study (20 and 19 in the intervention and control groups, respectively) and were included in the analysis. At week 12, the intervention group showed significant reductions in depression severity and perceived stress compared to the control group. Additionally, they reported increased perceived social support and demonstrated improved diabetes self-care behavior. These positive effects persisted through week 16, with the added benefit of reduced anxiety. While fasting glucose levels in the intervention group tended to improve, no other significant differences were observed in laboratory assessments between the groups. Conclusion This study provides compelling evidence for the potential efficacy of a mobile application that integrates physical and mental health components to address depressive symptoms and enhance diabetes self-management in disadvantaged individuals with type 2 diabetes mellitus and depression. Further research involving larger and more diverse populations is warranted to validate these findings and solidify their implications.

Background: Silk sericin is an active ingredient in bone grafts. However, the optimal scaffold for silk sericin has yet to be identified.Method A critical-sized bone defect model in rat calvaria was used to evaluate bone regeneration. Silk sericin from Yeonnokjam, Bombyx mori, was incorporated into gelatin (group G, n = 6) and collagen (group C, n = 6). Bone regen‑eration was evaluated using micro-computed tomography (mCT) and histology. Results: Group C showed a larger bone volume than group G in the mCT analysis (P = 0.001). Histological analysis showed a larger area of bony defects in group G than in group C. The bone regeneration area in group C was signifi‑cantly larger than that in group G (P = 0.003). Conclusion Compared with gelatin, collagen shows better bone regeneration in silk sericin-based bone grafts.

Objectives: ：This study aimed to investigate the prevalence of bullying behavior and its association with suicidal ideation among middle school students. Methods: ：This was a cross sectional study of a sample including 781 second grade middle school students(438 males and 343 females) in Gwang-ju metropolitan city. Information on bullying involvement, suicidal ideation and depressive/anxiety symptoms were collected using a self-administered questionnaire. Subjects were classified into subgroups of bully, victim, bully or victim, bully-victim, and witnessing. The data were analyzed using binary logistic regression analyses, adjusted for covariates. Results: ：The prevalence of bullying victimization, bullying perpetration, bullying witnessing and suicidal ideation were 26.5%, 24.5%, 21.6% and 26%, respectively. Suicidal ideation was positively correlated with bullying victimization, bullying perpetration, bullying witnessing. Using binary logistic regression analyses, the odds ratio of bully-victim group compared to non bullying involvement was 2.41, the highest among all groups. Conclusions ：Our findings indicate that school bullying, victim, and witnessing are associated with suicidal ideation, especially in bully and victim group. In addition, it is essential to develop prevention strategies and interventions for adolescents involved in any bullying involvement.

Objective: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2, is a global concern. This study aimed to examine the clinical characteristics, demographics and outcomes of COVID-19 patients in the emergency department (ED) and explore clinical predictors of in-hospital mortality. Methods: This single-center, retrospective, observational study used 1,003 adult patients with laboratory-confirmed COVID-19 who went to the ED and were admitted to the hospital between February 28 and September 30, 2020. Results: The median age of the included patients was 55 (37-68) years, and 533 were women (53.1%). Severe COVID-19 was noted in 173 patients (17.2%); seven patients (0.7%) received mechanical ventilation. The mortality rate was 2.1%. Multivariable Cox regression analysis found the risk factors associated with in-hospital death of patients (age >70 years [hazard ratio (HR), 27.411; P<0.001], albumin level <3.5 g/dL [HR, 12.273; P<0.001], CURB-65 [confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older] score ≥3 [HR, 10.137; P=0.002] and platelet count <100×109/L [HR, 3.281; P=0.024]) on admission. Conclusion Age>70 years, hypoalbuminemia, CURB-65≥3 and thrombocytopenia on admission were independent risk factors for mortality in patients hospitalized with COVID-19. Early detection of these predictors and application of CURB-65 score in the ED may provide guidance for appropriate risk stratification at triage and disposition of patients at increased risk of poor prognosis.

Objective: Internet gaming disorder (IGD) has attracted considerable attention as a serious mental and public health issue worldwide. Currently, there are no established treatment guidelines for IGD. Herein, we review the latest findings on the efficacy and related neural effects of pharmacological and psychosocial treatments for individuals with IGD. Methods: A database search of relevant studies published between 2007 and 2020 was conducted using PubMed and Google Scholar. Twenty-seven studies were reviewed for current evidence related to the efficacy and neural effects of pharmacological and psychosocial IGD treatments. Results: Pharmacological studies suggest that bupropion may play a significant role in IGD. Additionally, nuclear imaging studies on IGD have demonstrated functional impairment of the dopamine system, providing a neurobiological basis for the efficacy of dopamineenhancing drugs. Among the various psychosocial interventions, current evidence suggests that cognitive behavioral therapy may be an effective intervention for IGD. Cognitive behavioral therapy and bupropion were found to influence resting-state functional connectivity within the cortico-subcortical circuit and default mode network, suggesting a possible neural mechanism. Innovative approaches, including virtual reality treatment, residential camps, voluntary abstinence, and transcranial direct current stimulation, have shown promising results. However, methodological limitations, such as the absence of proper controls, small sample sizes, short duration, inconsistency of inclusion criteria across studies, and self-report measures of outcome, hamper conclusions regarding the efficacy of treatments. Conclusion Ongoing basic research and clinical trials overcoming these limitations could add to the existing knowledge on IGD and contribute to the development of evidence-based treatments.

The central type of Tapia’s syndrome is an extremely rare presentation, characterized by unilateral paralysis of the vagal and hypoglossal nerves, contralateral hemiparesis, or hemihypesthesia. This report describes a case of a middle-aged patient who developed central Tapia’s syndrome due to a right vertebral artery dissecting aneurysm (VADA). The patient complained about swallowing difficulty and odynophagia. Right vocal cord paralysis, mild tongue deviation to the right side, left hypesthesia, and decreased temperature sensation with left hemiparesis were observed in neurologic exams. A right VADA and compression of the medulla oblongata due to the VADA were diagnosed on magnetic resonance imaging. Endovascular flow diversion of the right VADA was performed. After 1 year, all neurological symptoms and vocal cord paralysis were nearly resolved, but left hypesthesia remained with decreased nociception. We present and discuss how a VADA caused those symptoms and propose endovascular flow diversion as a treatment option.

The central type of Tapia’s syndrome is an extremely rare presentation, characterized by unilateral paralysis of the vagal and hypoglossal nerves, contralateral hemiparesis, or hemihypesthesia. This report describes a case of a middle-aged patient who developed central Tapia’s syndrome due to a right vertebral artery dissecting aneurysm (VADA). The patient complained about swallowing difficulty and odynophagia. Right vocal cord paralysis, mild tongue deviation to the right side, left hypesthesia, and decreased temperature sensation with left hemiparesis were observed in neurologic exams. A right VADA and compression of the medulla oblongata due to the VADA were diagnosed on magnetic resonance imaging. Endovascular flow diversion of the right VADA was performed. After 1 year, all neurological symptoms and vocal cord paralysis were nearly resolved, but left hypesthesia remained with decreased nociception. We present and discuss how a VADA caused those symptoms and propose endovascular flow diversion as a treatment option.

Objectives: ：This study aimed to investigate the prevalence of internet game addiction and its association with environmental characteristics such as parent supervision, gaming hour (time spent on gaming) and attention-deficit hyperactivity disorder (ADHD) symptoms among middle school students. Methods: ：A total of 596 (416 males and 180 females) first grade middle-school students in Gwang-ju metropolitan city were included in this study. Subjects were asked to complete a self-reported questionnaire, including measures of the Internet Gaming Use-Elicited Symptom Screen (IGUESS), Attention deficit hyperactivity disorder (ADHD) symptom, environmental factor such as parent supervision, and game related factor like game hours. Internet Game addiction and non-addiction group were defined using IGUESS score of 10 as a cut-off. The data were analyzed using hierarchical regression analyses. Results: ：Internet Game addiction group was fifty-two subjects (8.7%). Male students were significantly higher than female students (OR 25.01). IGUESS score was statistically negatively correlated with parent attachment and parent supervision, while IGUESS score was positively correlated with time spent on gaming per day, the longest time spent on gaming per day and violent game and ADHD score. Among variables, IGUESS score showed the highest correlation with the longest time spent on gaming per day (r=0.373, p<0.01). Using hierarchical regression analyses, the longest time spent on gaming per day was also the highest predicting factor affecting internet game addiction among variables. Conclusion ：Our findings indicate that parent supervision, parent attachment and game related characteristics such as gaming per day, the longest time spent on gaming per day and violent game and ADHD were associated with internet game addiction.

PURPOSE: With the emergence of next-generation sequencing (NGS) technology, profiling a wide range of genomic alterations has become a possibility resulting in improved implementation of targeted cancer therapy. In Asian populations, the prevalence and spectrum of clinically actionable genetic alterations has not yet been determined because of a lack of studies examining high-throughput cancer genomic data. MATERIALS AND METHODS: To address this issue, 1,071 tumor samples were collected from five major cancer institutes in Korea and analyzed using targeted NGS at a centralized laboratory. Samples were either fresh frozen or formalin-fixed, paraffin embedded (FFPE) and the quality and yield of extracted genomic DNA was assessed. In order to estimate the effect of sample condition on the quality of sequencing results, tissue preparation method, specimen type (resected or biopsied) and tissue storage time were compared. RESULTS: We detected 7,360 non-synonymous point mutations, 1,164 small insertions and deletions, 3,173 copy number alterations, and 462 structural variants. Fifty-four percent of tumors had one or more clinically relevant genetic mutation. The distribution of actionable variants was variable among different genes. Fresh frozen tissues, surgically resected specimens, and recently obtained specimens generated superior sequencing results over FFPE tissues, biopsied specimens, and tissues with long storage duration. CONCLUSION: In order to overcome, challenges involved in bringing NGS testing into routine clinical use, a centralized laboratory model was designed that could improve the NGS workflows, provide appropriate turnaround times and control costs with goal of enabling precision medicine.
Academies and Institutes ; Asian Continental Ancestry Group ; DNA ; Humans ; Korea ; Methods ; Paraffin ; Point Mutation ; Precision Medicine ; Prevalence

BACKGROUND: The objective of this study was to evaluate the changes in gene expression after incubation of cells with proteins released from different silk mat layers. METHODS: A silk cocoon from Bombyx mori was separated into four layers of equal thickness. The layers were numbered from 1 to 4 (from the inner to the outer layer). The proteins were released by sonication of a silk mat layer in normal saline. The concentration of proteins was determined by spectrophotometry. They were incubated with RAW264.7 cells, and changes in the expression of genes were evaluated by cDNA microarray analysis and quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). RESULTS: Layer 1 and 4 groups had higher protein concentrations compared to those in layer 2 and 3 groups. The genes associated with inflammation and angiogenesis showed significantly higher expression in layer 1 and 4 groups. The results of qRT-PCR were in agreement with those of the cDNA microarray analysis. CONCLUSIONS: The silk mat from the middle portion of the silkworm cocoon yielded a lower protein release and caused an insignificant change in the expression of genes that are associated with inflammation and angiogenesis.
Angiogenesis Inducing Agents ; Bombyx ; Gene Expression ; Inflammation ; Macrophages ; Oligonucleotide Array Sequence Analysis ; Silk ; Sonication ; Spectrophotometry