INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. METHODS: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR). RESULTS: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR. CONCLUSION Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.
Humans ; Cross-Sectional Studies ; Pandemics ; COVID-19/epidemiology* ; Burnout, Psychological ; Health Personnel

OBJECTIVE: The incidence rate of stroke as a result of intracranial arterial stenosis (ICAS) is higher in Asian countries than in the West. We aimed to analyze the regression, lack of change, or progression of asymptomatic ICAS after the administration of rosuvastatin and associated factors.METHODS: The patients who had undergone computed tomography angiography (CTA) at our hospital and had been diagnosed with ICAS with no ischemic event in the stenosed vascular territory were included in the study. They were administered 20mg of rosuvastatin per day. After a follow-up period of at least 6 months after treatment, the patients were examined using CTA again and the clinical information and imaging results were analyzed.RESULTS: In total, 48 patients were diagnosed with asymptomatic ICAS. During the final follow-up examination, it was found that the stenotic lesion regressed in 30 patients, whereas it remained unchanged or progressed without any adverse effects in 18 patients. In univariate analysis, the regressed group showed significantly higher differences in the levels of total cholesterol and low-density lipoprotein (LDL) between their initial and final values (both, p=0.031 for both). In the multivariate analysis, a significantly higher difference in the levels of LDL between its initial and final measurement was seen in the regressed group (p=0.035, odds ratio(OR) 3.9).CONCLUSIONS: Rosuvastatin was found to have better lipid-lowering effects for total cholesterol and particularly LDL in patients whose ICAS had regressed. We concluded that rosuvastatin administration can be recommended for the treatment of patients with asymptomatic ICAS.
Angiography ; Asian Continental Ancestry Group ; Atherosclerosis ; Cholesterol ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Lipoproteins ; Multivariate Analysis ; Rosuvastatin Calcium ; Stroke

PURPOSE: To investigate the changes of visual acuity and central macular thickness (CMT) in patients with diabetic retinopathy (DR) receiving long-term hemodialysis (HD). METHODS: From January 1, 2008, to December 31, 2018, the medical records of patients who were diagnosed with DR receiving HD three times a week for ≥18 months due to chronic kidney disease (CKD) were analyzed. Among them, patients diagnosed with DR 6 months before the start of HD were included. Patients with vitreous hemorrhage (VH) affecting visual acuity (VA), other retinal diseases, and cataract surgery after HD were excluded. The VA and CMT before HD and at 1, 3, 6, 12, and 18 months after HD were analyzed. RESULTS: Of the 222 eyes of 111 patients who were diagnosed with DR and received HD for CKD due to diabetes, 174 eyes with DR diagnosed after starting HD were excluded. Ten eyes with VH before starting HD, two eyes with epiretinal membrane, and four eyes with cataract surgery after starting HD were also excluded. Thirty-two eyes of 18 patients were included. The mean age of the patients was 53.71 ± 9.25 years. Twenty-four males and eight female patients were included in the study. The mean logMAR VA improved significantly from 0.36 ± 0.28 before starting HD to 0.26 ± 0.27 at 18 months after starting HD (p = 0.002). The mean CMT was significantly decreased from 307.12 ± 89.52 µm before starting HD to 279.71 ± 61.75 µm at 12 months after starting HD (p = 0.02). CONCLUSIONS: In patients with DR who underwent long-term HD, CMT decreased and VA improved, when compared with these parameters before HD.
Cataract ; Diabetic Retinopathy ; Epiretinal Membrane ; Female ; Humans ; Macular Edema ; Male ; Medical Records ; Renal Dialysis ; Renal Insufficiency, Chronic ; Retinal Diseases ; Visual Acuity ; Vitreous Hemorrhage

BACKGROUND: Patients with acute myocardial infarction (AMI) have worse clinical outcomes than those with stable coronary artery disease despite revascularization. Non-culprit lesions of AMI also involve more adverse cardiovascular events. This study aimed to investigate the influence of AMI on endothelial function, neointimal progression, and inflammation in target and non-target vessels. METHODS: In castrated male pigs, AMI was induced by balloon occlusion and reperfusion into the left anterior descending artery (LAD). Everolimus-eluting stents (EES) were implanted in the LAD and left circumflex (LCX) artery 2 days after AMI induction. In the control group, EES were implanted in the LAD and LCX in a similar fashion without AMI induction. Endothelial function was assessed using acetylcholine infusion before enrollment, after the AMI or sham operation, and at 1 month follow-up. A histological examination was conducted 1 month after stenting. RESULTS: A total of 10 pigs implanted with 20 EES in the LAD and LCX were included. Significant paradoxical vasoconstriction was assessed after acetylcholine challenge in the AMI group compared with the control group. In the histologic analysis, the AMI group showed a larger neointimal area and larger area of stenosis than the control group after EES implantation. Peri-strut inflammation and fibrin formation were significant in the AMI group without differences in injury score. The non-target vessel of the AMI also showed similar findings to the target vessel compared with the control group. CONCLUSION: In the pig model, AMI events induced endothelial dysfunction, inflammation, and neointimal progression in the target and non-target vessels.
Acetylcholine ; Arteries ; Balloon Occlusion ; Constriction, Pathologic ; Coronary Artery Disease ; Drug-Eluting Stents ; Endothelium ; Fibrin ; Follow-Up Studies ; Humans ; Inflammation ; Male ; Myocardial Infarction ; Reperfusion ; Stents ; Swine ; Vasoconstriction

OBJECTIVES: The purpose of this study was to investigate the distinctive features of bodily panic symptoms and the predisposing conditions in Korean patients with panic disorder. METHODS: This was a retrospective chart review study and the data were collected from twelve university-affiliated hospitals in Korea. The patients selected met the diagnostic criteria for panic disorder, were older than 20 years of age, and had initially visited a psychiatry department. The assessments included the chief complaints related to bodily panic symptoms, recent stressors, recent history of alcohol and sleep problems, and time to visit an outpatient clinic. RESULTS: A total of 814 participants were included in the study. The most commonly experienced symptoms were cardiovascular and respiratory symptoms, which were observed in 63.9% and 55.4% of participants, respectively. Just before the onset of a panic attack, 25.6% of participants experienced sleep-related problems. Episodic binge drinking was also frequently observed (13.2%) and was more prevalent in men than in women (22.6% vs. 4.9%, p<0.001). About 75% of participants experienced stressful life events just before panic onset. Work-related issues were more prevalent in men than in women (22.0% vs. 13.4%, p=0.001). Family-related issues (4.8% vs. 14.1%, p<0.001) and conflict with a spouse or partner (4.0% vs.11.7%, p<0.001) were more prominent in women than in men. CONCLUSION Our results suggest that cardiovascular symptoms are the most common bodily panic symptoms in Korean patients. Our results suggest that a substantial portion of the Korean patients experienced stressful life events, sleep problems, and/or episodic binge drinking just before the onset of panic disorder.

OBJECTIVES: The purpose of this study was to identify and compare the difference and related factors with general characteristic and health behaviors, a experience of diagnosis and treatment of chronic diseases between rural and urban among elderly in Korea. METHODS: We used the data of Community Health Survey 2017 which were collected by the Korean Center for Disease Control and Prevention. The study population comprised 67,835 elderly peopled aged 65 years or older who participated in the survey. The chi-square test, univariate and multivariate logistic regression analysis were used to analyze data. RESULTS: We identified many significant difference of health behaviors, an experience of diagnosis and treatment with chronic diseases between rural and urban. Compared to urban elderly, the odds ratios (ORs) (95% confidence interval) of rural elderly were 1.136 (1.092–1.183) for diagnosis of diabetes, 1.278 (1.278–1.386) for diagnosis of dyslipidemia, 0.940 (0.904–0.977) for diagnosis of arthritis, 0.785(0.736–0.837) for treatment of arthritis, 1.159 (1.116–1.203) for diagnosis of cataracts, and 1.285(1.200–1.375) for treatment of cataracts. In the experience of diagnosis and treatment of chronic diseases, various variables were derived as contributing factors for each disease. Especially, there were statistically significant difference in the experience of diabetes diagnosis, arthritis diagnosis, cataract diagnosis and dyslipidemia except for hypertension diagnosis (p<0.01) between urban and rural elderly. There were statistically significant differences in the experience of treatment for arthritis and cataract (p<0.01), but there was no significant difference in the experience of treatment for hypertension, diabetes, dyslipidemia between urban and rural elderly. CONCLUSION Therefore, it would be necessary to implement a strategic health management project for diseases that showed significant experience of chronic diseases with diagnosis and treatment, reflecting the related factors of the elderly chronic diseases among the urban and rural areas.

OBJECTIVE: The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea. METHODS: We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis. RESULTS: Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians. CONCLUSION: This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.
Antidepressive Agents ; Anxiety Disorders ; Anxiety ; Benzodiazepines ; Citalopram ; Consensus ; Drug Therapy ; Korea ; Paroxetine ; Propranolol ; Psychotropic Drugs ; Serotonin Uptake Inhibitors ; Sertraline ; Venlafaxine Hydrochloride

A nucleobase adenine is a fundamental component of nucleic acids and adenine nucleotides. Various biological roles of adenine have been discovered. It is not produced from degradation of adenine nucleotides in mammals but produced mainly during polyamine synthesis by dividing cells. Anti-inflammatory roles of adenine have been supported in IgE-mediated allergic reactions, immunological functions of lymphocytes and dextran sodium sulfate-induced colitis. However adenine effects on Toll-like receptor 4 (TLR4)-mediated inflammation by lipopolysaccharide (LPS), a cell wall component of Gram negative bacteria, is not examined. Here we investigated anti-inflammatory roles of adenine in LPS-stimulated immune cells, including a macrophage cell line RAW264.7 and bone marrow derived mast cells (BMMCs) and peritoneal cells in mice. In RAW264.7 cells stimulated with LPS, adenine inhibited production of pro-inflammatory cytokines TNF-α and IL-6 and inflammatory lipid mediators, prostaglandin E₂ and leukotriene B₄. Adenine impeded signaling pathways eliciting production of these inflammatory mediators. It suppressed IκB phosphorylation, nuclear translocation of nuclear factor κB (NF-κB), phosphorylation of Akt and mitogen activated protein kinases (MAPKs) JNK and ERK. Although adenine raised cellular AMP which could activate AMP-dependent protein kinase (AMPK), the enzyme activity was not enhanced. In BMMCs, adenine inhibited the LPS-induced production of TNF-α, IL-6 and IL-13 and also hindered phosphorylation of NF-κB and Akt. In peritoneal cavity, adenine suppressed the LPS-induced production of TNF-α and IL-6 by peritoneal cells in mice. These results show that adenine attenuates the LPS-induced inflammatory reactions.
Adenine Nucleotides ; Adenine* ; Animals ; Bone Marrow ; Cell Line ; Cell Wall ; Colitis ; Cytokines ; Dextrans ; Gram-Negative Bacteria ; Hypersensitivity ; Inflammation ; Interleukin-13 ; Interleukin-6 ; Lymphocytes ; Macrophages ; Mammals ; Mast Cells ; Mice ; Mitogen-Activated Protein Kinases ; Nucleic Acids ; Peritoneal Cavity ; Phosphorylation ; Protein Kinases ; Sodium ; Toll-Like Receptor 4

Mast cells are major immune cells in allergy to secrete allergic mediators by a degranulation process and make and secrete inflammatory lipids and cytokines in response to antigen stimulation. An amino acid tryptophan regulates immune functions. Tryptophan ameliorates inflammatory colitis in which mast cells are engaged. However, its effects on mast cells remain to be solved. We investigated the effect of tryptophan on IgE-mediated allergic responses in the mast cells and mice. IgE-mediated passive cutaneous anaphylaxis (PCA) in mice were examined. Also IgE-mediated mast cell activation responses such as degranulation of stored granules and secretion of inflammatory lipid LTB₄ and cytokines (TNF-α and IL-4) were measured. Intraperitoneal administration of tryptophan suppressed PCA in mice. Also, in the cellular level tryptophan inhibited IgE-mediated mast cell activation such as IgE-mediated degranulation and the production of LTB₄. Also, it inhibited production of inflammatory cytokines TNF-α and IL-4. In summary, tryptophan suppressed IgE-mediated allergic activation in vivo and in vitro. Tryptophan supplementation is beneficial for IgE-mediated allergy.
Animals ; Colitis ; Cytokines ; Hypersensitivity ; Immunoglobulin E ; In Vitro Techniques ; Interleukin-4 ; Leukotriene B4 ; Mast Cells* ; Mice ; Passive Cutaneous Anaphylaxis ; Tryptophan*

One Korean company recently successfully produced a robotic surgical system prototype called Revo-i (MSR-5000). We, therefore, conducted a preclinical study for robotic cholecystectomy using Revo-i, and this is a report of the first case of robotic cholecystectomy performed using the Revo-i system in a preclinical porcine model. Revo-i consists of a surgeon console (MSRC-5000), operation cart (MSRO-5000) and vision cart (MSRV-5000), and a 40 kg-healthy female porcine was prepared for robotic cholecystectomy with general anesthesia. The primary end point was the safe completion of these procedures using Revo-i: The total operation time was 88 minutes. The dissection time was defined as the time from the initial dissection of the Calot area to the time to complete gallbladder detachment from the liver bed: The dissection time required 14 minutes. The surgical console time was 45 minutes. There was no gallbladder perforation or significant bleeding noted during the procedure. The porcine survived for two weeks postoperatively without any complications. Like the da Vinci surgical system, the Revo-i provides a three-dimensional operative view and allows for angulated instrument motion (forceps, needle-holders, clip-appliers, scissors, bipolar energy, and hook monopolar energy), facilitating an effective laparoscopic procedure. Our experience suggests that robotic cholecystectomy can be safely completed in a porcine model using Revo-i.
Anesthesia, General ; Cholecystectomy* ; Device Approval ; Female ; Gallbladder ; Hemorrhage ; Humans ; Liver ; Robotic Surgical Procedures