Objective: The relationship among physical functional decline, low-grade inflammation, and depression remains unclear. The aim of this study was to examine the association between hand grip strength (HGS) and high-sensitivity C-reactive protein (hs-CRP) in a large sample with depression. Methods: This study used data obtained from a representative Korean sample of 9,402 people who participated in the seventh Korean National Health and Nutrition Examination Survey. Physical function was assessed using a digital grip strength dynamometer. Depression was identified using a cutoff of 5 on the Patient Health Questionnaire-9 (PHQ-9), and high hs-CPR level was defined as ≥ 3.0 mg/L. Results: In older adults (≥ 60 years) with depression, 43.8% of those with high hs-CRP levels had low HGS, compared to 21.8% of those with hs-CRP levels ＜ 3.0 mg/L (p = 0.002). Multivariate analysis revealed that, after adjustments for potentially confounding factors, high hs-CRP was independently associated with lower HGS (B = −2.25; 95% confidence interval = −4.49 to −0.02) in older adults with depression, but not in younger or middle-aged adults with depression. Conclusion These findings suggest a significant correlation between physical functional decline and low-grade inflammation in older adults with depression.

Concern for patient safety underlies the need for interprofessional education (IPE). One way to measure the effectiveness of IPE is by measuring attitude change toward other healthcare professionals; however, there are currently no valid Korean tools to measure such a change in attitudes. Therefore, this study aims to develop and test a Korean version of the Interprofessional Attitudes Scale (IPAS). The original IPAS was translated into Korean according to the World Health Organization’s guidelines after obtaining permission from the article’s corresponding author. A total of 414 questionnaires were collected from third- and fourth-year medical and nursing students at four Korean institutions in December 2018. To analyze the validity of the Korean IPAS, exploratory and confirmatory factor analyses were conducted. Cronbach’s α was used to evaluate reliability. Results from the exploratory factor analysis identified four functions: teamwork, community-centeredness, patient-centeredness, and respect for diversity. Significant cross-correlations were found among the four functions (r=0.438–0.631, p<0.001) along with overall reliability (Cronbach’s α=0.929) and reliability of each subfactor (Cronbach’s α=0.804–0.897). This study verified the validity and reliability of the Korean version of the IPAS, so this scale can be used in the future to measure the effectiveness of IPE in Korea.

PURPOSE: This study investigated the attitudes of Korean medical students about patient safety to determine which perspectives required increased focus in terms of educational development. METHODS: Attitudes were assessed using the Patient Safety Questionnaire, a tool designed to measure attitudes toward patient safety among medical students. Questionnaires were distributed to 580 clinical year students across four medical schools in December 2018. RESULTS: A total of 300 returned questionnaires were used in the final analysis. More than half of all respondents agreed (i.e., gave more than 4 out of 7 points) with most items and thoroughly considered the concept of patient safety. However, many students misperceived several items (e.g., professional incompetence as a cause of errors, disclosure responsibility, the importance of patient safety in the curriculum, and situational awareness). CONCLUSION Attitudes toward patient safety are highly important due to their substantial impacts on behavioral decisions in the clinical setting. As such, patient safety education should be designed to place greater emphasis on proper attitude. This study's findings should be useful for medical instructors who wish to determine the appropriate areas of curricular focus.

Interprofessional education (IPE) can promote high-quality patient care and good medical outcomes through teamwork among health professionals. However, there are no valid measurements to prove the effectiveness of IPE in Korea. This study aimed to develop and test a Korean version of the Self-efficacy for Interprofessional Experimental Learning Scale (SEIEL). The original SEIEL was translated into Korean by two experienced medical professors, and 368 questionnaires were collected from medical and nursing students (third and fourth year). To analyze the validity of the Korean version of the SEIEL, an exploratory and confirmatory factor analysis was conducted. Cronbach's α was used to evaluate reliability. Results from the exploratory factor analysis identified two functions: “interprofessional collaboration” and “interprofessional team evaluation.” A significant cross-correlation was found between the two functions (r=0.690, p<0.001), with a Cronbach's α value of 0.932. The reliability and validity of the Korean version of the SEIEL was identified in this study. This tool can be helpful in measuring the effectiveness of IPE in Korea.

PURPOSE: This study investigated the attitudes of Korean medical students about patient safety to determine which perspectives required increased focus in terms of educational development. METHODS: Attitudes were assessed using the Patient Safety Questionnaire, a tool designed to measure attitudes toward patient safety among medical students. Questionnaires were distributed to 580 clinical year students across four medical schools in December 2018. RESULTS: A total of 300 returned questionnaires were used in the final analysis. More than half of all respondents agreed (i.e., gave more than 4 out of 7 points) with most items and thoroughly considered the concept of patient safety. However, many students misperceived several items (e.g., professional incompetence as a cause of errors, disclosure responsibility, the importance of patient safety in the curriculum, and situational awareness). CONCLUSION: Attitudes toward patient safety are highly important due to their substantial impacts on behavioral decisions in the clinical setting. As such, patient safety education should be designed to place greater emphasis on proper attitude. This study's findings should be useful for medical instructors who wish to determine the appropriate areas of curricular focus.
Curriculum ; Disclosure ; Education ; Education, Medical ; Humans ; Patient Safety ; Schools, Medical ; Students, Medical ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to evaluate the radiologic outcomes of distal fibular fractures and to analyze the risk factors associated with nonunion. MATERIALS AND METHODS: Between January 2009 and March 2016, 13 patients who had final nonunion with ankle fracture were included. In the control group, 370 patients who had undergone bony union and removed metal implants were included. All patients underwent the same surgical procedure and had the same treatment method, ultimately achieving satisfactory open reduction results with less than 2 mm fracture gap. Surgical treatment of fracture was considered to have the same effect on nonunion, and factors that might be associated with nonunion were evaluated. SPSS ver. 13.0 (SPSS Inc., USA) was used for all statistical analyses. Pearson's chi-square test and multi-variate regression analysis were performed to determine the factors affecting nonunion of distal fibular fracture. A p-value less than 0.05 was considered statistically significant, and relative risk was assessed. RESULTS: The mean age of 13 patients was 46.9 years (range, 16~57 years); there were 8 men and 5 women. Among the 13 patients with nonunion, atrophic was the most common (12 cases). The association between the injury mechanism and the Lauge-Hansen classification and diabetes mellitus was not statistically significant. Distal fibular fractures with tibia shaft fracture (p=0.015) and Danis-Weber type C fracture (p=0.023), open fracture (p=0.011), and smoking (p=0.023) were significantly associated with nonunion. CONCLUSION: In this study, the combined injury of the ipsilateral tibia shaft fracture, open fracture, and Danis-Weber type C fracture may increase the possibility of nonunion. Therefore, caution is advised to prevent nonunion.
Ankle Fractures ; Classification ; Diabetes Mellitus ; Female ; Fractures, Open ; Humans ; Male ; Methods ; Risk Factors* ; Smoke ; Smoking ; Tibia

PURPOSE: In this study, we evaluated the associations between intraocular pressure (IOP) and systemic and socioeconomic factors. METHODS: A population-based cross-sectional study using a nation-wide, stratified, multistage, clustered sampling method included 15,421 subjects aged ≥20 years with no history of ocular surgery or glaucoma who participated in the Korean National Health and Nutritional Examination Survey 2008-2011. RESULTS: Univariate regression analyses showed statistically significant linear relationships between IOP and body mass index (BMI), smoking status, heavy drinking, systolic blood pressure, fasting blood glucose, total cholesterol, triglycerides, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), metabolic syndrome (p < 0.001, respectively), low density lipoprotein cholesterol (p = 0.003), refractive error (p < 0.001), and office work (p = 0.029). In addition, analysis of variance (ANOVA) showed statistically significant differences in IOP and refraction according to occupation (p < 0.001, all). CONCLUSIONS: We concluded that increased IOP was associated with age, BMI, heavy drinking, systolic blood pressure, total cholesterol, and refraction. There were statistically significant differences in IOP and refraction according to occupation.
Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol ; Cholesterol, LDL ; Cross-Sectional Studies ; Drinking ; Fasting ; Glaucoma ; Homeostasis ; Insulin ; Insulin Resistance ; Intraocular Pressure* ; Methods ; Occupations ; Refractive Errors ; Smoke ; Smoking ; Socioeconomic Factors ; Triglycerides

BACKGROUND: Renal tubulointerstitial fibrosis is a common feature of the final stage of nearly all cause types of chronic kidney disease. Although classic peroxisome proliferator-activated receptor γ (PPARγ) agonists have a protective effect on diabetic nephropathy, much less is known about their direct effects in renal fibrosis. This study aimed to investigate possible beneficial effects of lobeglitazone, a novel PPARγ agonist, on renal fibrosis in mice. METHODS: We examined the effects of lobeglitazone on renal tubulointerstitial fibrosis in unilateral ureteral obstruction (UUO) induced renal fibrosis mice. We further defined the role of lobeglitazone on transforming growth factor (TGF)-signaling pathways in renal tubulointerstitial fibrosis through in vivo and in vitro study. RESULTS: Through hematoxylin/eosin and sirius red staining, we observed that lobeglitazone effectively attenuates UUO-induced renal atrophy and fibrosis. Immunohistochemical analysis in conjunction with quantitative reverse transcription polymerase chain reaction and Western blot analysis revealed that lobeglitazone treatment inhibited UUO-induced upregulation of renal Smad-3 phosphorylation, α-smooth muscle actin, plasminogen activator inhibitor 1, and type 1 collagen. In vitro experiments with rat mesangial cells and NRK-49F renal fibroblast cells suggested that the effects of lobeglitazone on UUO-induced renal fibrosis are mediated by inhibition of the TGF-β/Smad signaling pathway. CONCLUSION: The present study demonstrates that lobeglitazone has a protective effect on UUO-induced renal fibrosis, suggesting that its clinical applications could extend to the treatment of non-diabetic origin renal disease.
Actins ; Animals ; Atrophy ; Blotting, Western ; Collagen Type I ; Diabetic Nephropathies ; Fibroblasts ; Fibrosis* ; In Vitro Techniques ; Mesangial Cells ; Mice* ; Peroxisomes* ; Phosphorylation ; Plasminogen Activator Inhibitor 1 ; Polymerase Chain Reaction ; Rats ; Renal Insufficiency, Chronic ; Reverse Transcription ; Transforming Growth Factor beta ; Transforming Growth Factors ; Up-Regulation ; Ureter* ; Ureteral Obstruction*

OBJECTIVE: To investigate the associations among platelet indices, disease activity scores, and inflammatory markers in axial spondyloarthritis, and to determine the relation between platelet indices and inflammation measured on magnetic resonance imaging (MRI). METHODS: The study included 161 patients who fulfilled Assessment of Spondyloarthritis International Society criteria. Platelet indices such as mean platelet volume (MPV), plateletcrit (PCT), platelet large cell ratio (PLCR), and platelet distribution width (PDW) were measured. Ninety patients underwent sacroiliac (SI) MRI at baseline. Bone marrow edema (BME) and erosion on MRI were scored using the SPondyloArthritis Research Consortium of Canada (SPARCC) method. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and spinal radiologic progression were also assessed. The associations among platelet indices and disease activity scores and inflammatory markers were evaluated. RESULTS: Of the 161 patients, 130 (81%) were male. MPV, PLCR, and PDW were negatively associated with ASDAS and inflammatory marker expression, whereas PCT was positively associated with these parameters. MPV, PLCR, and PDW were negatively associated with BME and erosion scores on SI MRI. However, platelet indices were not associated with the BASDAI and BASFI. The mean erythrocyte sedimentation rate, C-reactive protein, and BME and erosion scores were significantly higher in patients with low MPV. Changes in MPV, PCT, and PDW at baseline and after one year were associated with changes in ASDAS and inflammatory marker expression. CONCLUSION: Platelet indices are associated with ASDAS, inflammatory marker levels, and severity of BME and erosion measured on MRI.
Baths ; Blood Platelets* ; Blood Sedimentation ; Bone Marrow ; C-Reactive Protein ; Canada ; Edema ; Humans ; Inflammation ; Magnetic Resonance Imaging* ; Male ; Mean Platelet Volume ; Methods ; Sacroiliitis* ; Spondylitis, Ankylosing

BACKGROUND: Pityriasis lichenoides (PL)-like skin lesions rarely appear as a specific manifestation of mycosis fungoides (MF). OBJECTIVE: We investigated the clinicopathological features, immunophenotypes, and treatments of PL-like MF. METHODS: This study included 15 patients with PL-like lesions selected from a population of 316 patients diagnosed with MF at one institution. RESULTS: The patients were between 4 and 59 years of age. Four patients were older than 20 years of age. All of the patients had early-stage MF. In all patients, the atypical lymphocytic infiltrate had a perivascular distribution with epidermotropism. The CD4/CD8 ratio was <1 in 12 patients. Thirteen patients were treated with either narrowband ultraviolet B (NBUVB) or psoralen+ultraviolet A (PUVA), and all of them had complete responses. CONCLUSION: PL-like MF appears to have a favorable prognosis and occurrence of this variant in adults is uncommon. MF should be suspected in the case of a PL-like skin eruption. Therefore, biopsy is required to confirm the diagnosis of PL-like MF, and NBUVB is a clinically effective treatment.
Adult ; Biopsy ; Diagnosis ; Humans ; Mycosis Fungoides* ; Phototherapy* ; Pityriasis Lichenoides ; Pityriasis* ; Prognosis ; Skin