Journal of Korean Medical Science最新文献

Background: This study investigates the hypothesis that the red, doughnut-shaped discs in Gustav Klimt's iconic painting 'The Kiss' represent red blood cells (RBCs). The purpose is to explore the artistic and anatomical significance of these elements, examining how Klimt may have integrated contemporary scientific discoveries into his work to convey deeper symbolic meanings.

Methods: This interdisciplinary study employed a combination of medical and art history approaches, including biographical analysis, literature review and a questionnaire survey to assess viewer's perceptions of the red discs in 'The Kiss.' The survey compared responses to the original painting with those to an experimentally altered version, where the red discs were removed, with the objective of determining the significance of these red discs in the artwork. The survey was conducted among 300 visitors at the Ulsan International Art Fair. Among the visitors, 69.3% of the participants were female, and the most common age group was 30-49 years old.

Results: Historical research and literature analysis revealed that the red disc-shaped patterns on the woman's dress in Klimt's painting closely resemble RBCs as depicted in early 20th-century scientific literature and encyclopedias. This suggests that Klimt, likely influenced by his interactions with medical scientists, intentionally incorporated contemporary scientific imagery into his artwork. The survey results indicated that 86.7% of participants recognized the painting as 'The Kiss,' demonstrating high familiarity with the piece. Comparisons between the original and altered versions of the painting revealed that viewers perceived notable differences in feeling, color perception, mood, and lighting.

Conclusion: This study demonstrates that Klimt intentionally incorporated RBC-like motifs into his paintings, using them not only to convey anatomical symbolism and emotional depth but also as dynamic elements within a mosaic pattern. These red elements energize not only the female figure in 'The Kiss' but the entire composition. Klimt's work reveals his skill in merging scientific concepts with visual and emotional expression, showcasing an innovative approach to embedding complex medical and emotional meanings through the use of symbolic imagery.

Background: This survey examined healthcare professionals' knowledge, views, and perceptions of the responsibilities and functions of Research Ethics Committees (RECs). The study aimed to analyze ethical principles and operational issues faced by RECs and guide researchers, journal editors, and publishers on publication ethics notes.

Methods: A cross-sectional survey was conducted using the SurveyMonkey.com platform to assess healthcare professionals' knowledge, views, and practices concerning RECs' responsibilities, functions, and roles. The survey focused on REC definitions, functions, research types that require REC approval, and research protocols' evaluation time frames. It also reflected on ethics considerations and REC adaptations during the coronavirus disease 2019 (COVID-19) pandemic, REC member qualifications, evaluation periods, and additional challenges confronting RECs. Convenience sampling was adopted, and the survey was distributed via social media platforms.

Results: The survey was based on an analysis of questionnaires filled by 182 responders (104 females [57.1%] and 76 males [41.8%]), with a median age of 36. The survey respondents were from 28 different countries. The top three countries with most responders were Kazakhstan (n = 83), Türkiye (n = 33) and Poland (n = 10). Most participants (n = 128, 70.3%) were familiar with the definition of RECs and recognized the importance of REC approval for clinical trials and interventional research. Research study protocols should be submitted for REC evaluation and approval during the planning phase, according to 145 responders (79.7%). Participants emphasized the significance of formal ethics training for REC members. The involvement in research approved by RECs was also viewed as an important precondition for membering RECs. Participants suggested online submissions (n = 127, 69.8%), virtual meetings (n = 99, 54.4%), and fast evaluation schedules for low-risk research protocols (n = 77, 42.3%) during the COVID-19 pandemic.

Conclusion: Healthcare professionals comprehend the basics of REC duties and responsibilities. However, improvements in the consistency and efficiency of ethics evaluations are still warranted. The COVID-19 pandemic stressed the importance of adaptive REC procedures; researchers, editors, and publishers learned a vitally important lesson. More efforts are warranted to increase REC member training, simplify administrative procedures, and define standard operating procedures in times of crisis. Continuous progress in these areas will allow RECs to maintain high ethical standards while supporting productive research. Editors and publishers will greatly benefit from related advances in research ethics considerations.

Cartoons in scholarly publishing are effective ways to improve communication and engagement. They can transform scientific concepts into visually interesting and easy-to-understand formats, thereby helping the concepts reach to larger groups more easily. Depending on the type of cartoons (concept cartoons, humor illustrations, and editorial cartoons), benefits may vary. It is recommended to maintain relevance, elegance, and quality in cartoon presentations. Potential insults must be carefully avoided to maintain respectful communication. The objectives of the current article were to examine the complex roles of cartoons in scholarly publishing, to provide recommendations for drawing scientific cartoons, and to discuss challenges in incorporating cartoons into scientific publishing.

Background: Adiposity rebound (AR) refers to the period during growth when the body mass index reaches its lowest point before increasing again. The timing of AR is associated with the development of obesity and puberty onset. Although studies have evaluated AR timing in Korean children, none has focused on children born small for gestational age (SGA).

Methods: This study analyzed data from a multicenter observational clinical trial (LG Growth Study) to determine AR timing in children born SGA without catch-up growth (CUG) who were treated with growth hormone (GH) therapy. The study also aimed to identify factors associated with AR timing, examine the influence of AR timing on puberty onset, and assess the effectiveness of GH therapy.

Results: A total of 151 children born SGA without CUG were included. Of them, 15% experienced AR between 4 and 5 years of age, 42% between 5 and 6 years, 27% between 6 and 7 years, and 16% after 7 years of age. A significant positive correlation was noted between the height standard deviation score at the start of treatment and AR timing. However, no significant correlation was observed between AR timing and puberty onset or the effectiveness of GH therapy.

Conclusion: This study provides insights into AR timing in prepubertal children who meet the specific SGA criteria and its relationship with growth outcomes. The findings suggest that AR in children born SGA who do not experience CUG occurs later than in the general population, with no significant relationship between AR timing and puberty onset or growth outcomes.

Trial registration: ClinicalTrials.gov Identifier: NCT01604395.

Background: Clostridioides difficile infection (CDI) is one of the most common hospital-acquired infections, with its incidence and disease burden increasing markedly worldwide over the past decade.

Methods: To assess the attributable costs of CDI in Korea, the expenses related to hospital management of CDI cases were computed. This analysis used data from the National Health Insurance Service-National Sample Cohort spanning a decade (2010-2019). The annual national burden of CDI was determined by combining the attributable cost per CDI case with the number of patients with CDI obtained from the Health Insurance Review and Assessment Service data.

Results: The attributable costs of CDI were determined based on variations in the length of hospital stay and medical costs between patients with CDI and control patients. The mean length of hospital stay was significantly longer for patients with CDI than that for control patients: 43.06 vs. 14.76 days (a difference of 28.30 days, P < 0.001). The adjusted medical costs (2019 = 100) for cases of CDI and controls were 11,162 USD and 3,318 USD, respectively, with a significant difference of 7,843 USD (P < 0.001). The cost of CDI per case exhibited a noticeable annual increase from 2010 to 2019, despite an annual decreasing trend in length of hospital stay. The estimated national cost attributed to CDI was $28.9 million in 2010; however, it increased gradually each year, reaching $205.6 million in 2019 (a 600% increase over 10 years).

Conclusion: CDI is associated with substantial healthcare costs in Korea. The economic burden of CDI has gradually increased in South Korea.

Echinococcosis, caused by the tapeworm Echinococcus, is rare in Korea and is primarily imported from endemic areas. We report a case of a 37-year-old Korean man with multiple large hepatic cysts, initially diagnosed as simple cysts at a local clinic in 2018. The patient had lived in Oman, an endemic area, for several months in 2016. Upon referral to a tertiary hospital in 2023, due to progressive cyst enlargement, liver magnetic resonance imaging revealed three large cysts with a water lily sign. Serum IgG against Echinococcus was positive by enzyme-linked immunosorbent assay. After diagnosis of echinococcosis, treatment with albendazole and puncture-aspiration-injection-reaspiration (PAIR) was performed. Microscopic and molecular analysis of cyst aspirates confirmed Echinococcus granulosus infection. Follow-up computed tomography demonstrated a reduction in cyst size, yet the emergence of a new right pleural effusion and consolidation in the left lower lobe of the lung necessitated the continuation of albendazole therapy. This case highlights the importance of thorough travel history, imaging findings, and the effectiveness of PAIR combined with albendazole in treating imported echinococcosis.

Background: Healthcare-associated infections impose a significant burden on antibiotic usage, healthcare expenditures, and morbidity. Therefore, it is crucial to revise policies to minimize such losses. This nationwide survey aimed to evaluate infection prevention and control (IPC) components in healthcare facilities and encourage improvements in acute care hospitals with inadequate infection prevention settings. This study aims to enhance the infection control capabilities of healthcare facilities.

Methods: From December 27, 2021, to May 13, 2022, we conducted a survey of 1,767 acute care hospitals in the Republic of Korea. A survey was conducted to evaluate the infection control components in 1,767 acute care hospitals. Infection control officers provided direct responses to a systematically developed questionnaire. Subsequently, 10% of the respondents were randomly selected for the site investigation.

Results: Overall, 1,197 (67.7%) hospitals responded to the online survey. On-site investigations were conducted at 125 hospitals. Hospitals with ≥ 150 beds are advised to have an IPC team under Article 3 of the Medical Service Act; however, only 87.0% (598/687) of hospitals with ≥ 100 beds had one. Conversely, 22.7% (116/510) of hospitals with < 100 beds had an IPC team. Regulations for hand hygiene, waste management, healthcare worker protection and safety, environmental cleaning, standard precautions, and prevention of the transmission of multidrug-resistant pathogens were present in 84.2%, 80.1%, 77.4%, 76.2%, 75.8%, and 63.5% of the hospitals, respectively. Hospitals with < 100 beds had low availability of all categories of standard operating procedures.

Conclusion: This study is the first national survey of acute care hospitals in the Republic of Korea. The data presented in the current study will improve the understanding of IPC status and will help establish a survey system. Our survey provides a basis for improving policies related to IPC in healthcare facilities.

Background: Rare cases of Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) have been reported following the coronavirus disease 2019 (COVID-19) vaccination; however, the association between COVID-19 vaccination and the risk of developing KD/MIS-C has not yet been established.

Methods: We conducted a self-controlled case series analysis using a large-linked database that connects the COVID-19 immunization registry with nationwide claims data. We identified individuals aged < 18 years who received their initial COVID-19 vaccination and had a KD/MIS-C diagnosis with a prescription for intravenous immunoglobulin or corticosteroids between October 18, 2021, and April 15, 2023. The observation period was set as 240 days from the date of the COVID-19 vaccination. The risk window was 60 days after vaccination, with the remaining observation period serving as the control window. The incidence rate ratios (IRRs) and 95% confidence intervals (CIs) in the risk versus control windows were estimated using the conditional Poisson regression model. We further analyzed the vaccine doses and types for secondary analysis. We also performed subgroup analyses stratified by sex, age, comorbidities, and other conditions and sensitivity analyses by varying the length of the risk window and outcome definition.

Results: Among 2,369,490 individuals who received the COVID-19 vaccination, 12 cases of KD/MIS-C were identified, which included five and seven patients in the risk and control windows, respectively. There was no increased risk of KD/MIS-C within the 60-day period of vaccination (IRR, 0.53; 95% CI, 0.17-1.60). Secondary subgroup and sensitivity analyses showed no significant increase in the risk of KD/MIS-C after COVID-19 vaccination, which is consistent with the results of the main analysis.

Conclusion: The results of this nationwide study suggest that the risk of developing KD/MIS-C did not increase after COVID-19 vaccination. However, owing to the lack of a sufficient number of cases, future studies utilizing multinational long-term follow-up databases should be conducted. Considering the increasing incidence of KD/MIS-C and the limited understanding of its precise biological mechanisms, additional research on KD/MIS-C is warranted.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort.

Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation.

Results: Of the 628 patients, 195 were < 50 years, 322 were 50-64 years and 111 were ≥ 65 years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were non-ambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient's age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465).

Conclusion: Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.