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Objective Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate.Methods We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide.Results The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p

Objective The purpose of this study was to evaluate the effects of adding music therapy (MT) to cognitive-behavioral therapy (CBT) on symptoms of smartphone/internet addiction and psychiatric comorbidities.Methods Overall, 155 patients diagnosed with addiction were assigned to either the CBT-MT group or CBT group. Both groups received CBT for 8 weeks, while the CBT-MT group received additional MT. The intervention was completed by 67 and 71 participants in the CBT-MT and CBT groups, respectively.Results The total scores of Young Internet Addiction Scale (YIAT) and Smartphone Addiction Proneness Scale (SAPS) decreased significantly (p

Background Obesity in adolescents is associated with their mental as well as physical health. Adolescents tend to have negative or distorted perceptions about their body weight; however, the effects of such weight misperception on mental health remain unclear. This study investigated the association between weight misperception and mental health in Korean adolescents. Methods The analysis was based on the Korea Youth Risk Behavior web-based survey 2017 dataset, which included data from 62,276 middle and high school students at 800 schools throughout Korea. The students were divided into three groups according to whether they overestimated their body weight, underestimated it, or had no misperception. The mental health characteristics of the overestimation and no misperception groups were compared through multiple logistic regression analysis. Results Based on their body mass index, male adolescents were more likely to be overweight than female adolescents (p < 0.001) and less likely to have weight misperception. The female adolescents were more likely to overestimate their body weight and less likely to underestimate it (p < 0.001). The male adolescents and female adolescents who overestimated their body weight had significantly lower levels of subjective happiness than their peers had and were more likely to experience subjective stress, sadness/despair, suicidal ideation, and suicide planning. Compared with their peers who have no misperception, male adolescents with overestimation were less likely to drink alcohol (odds ratio [OR], 0.903) or smoke (OR, 0.871), whereas female adolescents with overestimation were more likely to drink alcohol (OR, 1.107) and smoke (OR, 1.130). Conclusion Male and female adolescents who overestimated their body weight experienced more psychological problems. Thus, interventions to assist adolescents to gain realistic weight perception may be beneficial. Particularly, more attention needs to be given to female adolescents, who are more likely to overestimate their body weight compared with their male counterparts.

Recently, rehabilitative exercise therapies have been described as an important method of overcoming the limitations of the conventional therapies for Parkinson’s disease. The present study aimed to evaluate efficacy and safety of exercise therapies for Parkinson’s disease. Randomized controlled trials that evaluated exercise therapies in patients with Parkinson’s disease until December 2016 were searched for in five electronic databases: PubMed, CENTRAL, EMBASE, OASIS, and CNKI. Eighteen studies (1,144 patients) were included. The overall methodological quality was not high. Patients who underwent exercise therapies exhibited statistically significant improvements in the total UPDRS, UPDRS II and III, Berg Balance Scale, preferred walking speed, and Timed Up and Go Test compared to patients who underwent nonexercise therapies. In comparison to patients who performed regular activity, patients who underwent exercise therapies exhibited statistically significant improvements in the total UPDRS, UPDRS II, and UPDRS III. Exercise therapies were found to be relatively safe. Exercise therapies might promote improvements in the motor symptoms of Parkinson’s disease. However, due to the small number of randomized controlled trials and methodological limitations, we are unable to draw concrete conclusions. Therefore, further studies with better designs will be needed.

Background: Stroke is a major health issue worldwide. Since Chinese herbal medicine is widely used for the treatment of stroke, there is a need to evaluate its efficacy as an alternative treatment option. The aim of this paper is to carry out an overview of Chinese herbal medicine for the treatment of stroke by summarizing and evaluating all existing Cochrane reviews. Methods: The Cochrane Database of Systematic Reviews was searched from its inception date to August 2019 using “stroke” and “herbal medicine” or “traditional medicine” as search terms. For the methodological quality assessment of the Cochrane reviews, the Assessment of Multiple Systematic Reviews (AMSTAR) tool was used. Results: Eight Cochrane reviews that evaluated the efficacy of herbal medicine for the treatment of stroke were included in this overview. There were 71 randomized controlled trials, with 5770 patients in total. The AMSTAR scores of the Cochrane reviews included in this study ranged from 9 to 11 with a mean score of 10. Three reviews met all the 11-item criteria of the AMSTAR. All reviews presented potential efficacy of herbal medicine for stroke treatment in terms of improvement of neurological deficit. Conclusions: This overview reveals the potential efficacy of herbal medicines for the treatment of stroke in terms of neurological deficit improvement. However, due to the high risk of bias in the reviews’ studies, an affirmative conclusion for the recommendation of herbal medicine for clinical practice could not be drawn. Keywords: Chinese herbal medicine, Stroke, Overview, Cochrane reviews

Patients with Behçet’s disease often use complementary and alternative medicine for treating their symptoms, and herbal medicine is one of the options. This systematic review provides updated clinical evidence of the effectiveness of herbal medicine for the treatment of Behçet’s disease (BD). We searched eleven electronic databases from inception to March 2020. All randomized controlled trials (RCTs) or quasi-RCTs of BD treatment with herbal medicine decoctions were included. We used the Cochrane Handbook for Systematic Reviews of Interventions to assess the risk of bias and the grading of recommendations assessment, development and evaluation (GRADE) approach to assess the certainty of evidence (CoE). Albatross plot was also used to present the direction of effect observed. Eight studies were included. The risk of bias was unclear or low. The methodological quality was low or very low. Seven RCTs showed significant effects of herbal medicine on the total response rate (Risk ratio, RR 1.26, 95% CI 1.09 to 1.45, seven studies, very low CoE). Four RCTs showed favorable effects of herbal medicine on the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level compared with drug therapy. Herbal medicine favorably affected the ESR (MD −5.56, 95% CI −9.99 to −1.12, p = 0.01, I2 = 96%, five studies, very low CoE). However, herbal medicine did not have a superior effect on CRP. Two RCTs reported that herbal medicine significantly decreased the recurrence rate after three months of follow-up (RR 0.23, 95% CI 0.09 to 0.63, two studies, low CoE). Our findings suggest that herbal medicine is effective in treating BD. However, the included studies had a poor methodological quality and some limitations. Well-designed clinical trials with large sample sizes are needed.

The authors developed and validated a diagnostic algorithm using the optimal upper and lower cut‐off values of office and home BP at which ambulatory BP measurements need to be applied. Patients presenting with high BP (≥140/90 mm Hg) at the outpatient clinic were referred to measure office, home, and ambulatory BP. Office and home BP were divided into hypertension, intermediate (requiring diagnosis using ambulatory BP), and normotension zones. The upper and lower BP cut‐off levels of intermediate zone were determined corresponding to a level of 95% specificity and 95% sensitivity for detecting daytime ambulatory hypertension by using the receiver operator characteristic curve. A diagnostic algorithm using three methods, OBP‐ABP: office BP measurement and subsequent ambulatory BP measurements if office BP is intermediate zone; OBP‐HBP‐ABP: office BP, subsequent home BP measurement if office BP is within intermediate zone and subsequent ambulatory BP measurement if home BP is within intermediate zone; and HBP‐ABP: home BP measurement and subsequent ambulatory BP measurements if home BP is within intermediate zone, were developed and validated. In the development population (n = 256), the developed algorithm yielded better diagnostic accuracies than 75.8% (95%CI 70.1–80.9) for office BP alone and 76.2% (95%CI 70.5–81.3) for home BP alone as follows: 96.5% (95%CI: 93.4–98.4) for OBP‐ABP, 93.4% (95%CI: 89.6–96.1) for OBP‐HBP‐ABP, and 94.9% (95%CI: 91.5–97.3%) for HBP‐ABP. In the validation population (n = 399), the developed algorithm showed similarly improved diagnostic accuracy. The developed algorithm applying ambulatory BP measurement to the intermediate zone of office and home BP improves the diagnostic accuracy for hypertension.

Kyung Soo Woo, Su Hyun Bong, Tae Young Choi, Jun Won Kim Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of KoreaCorrespondence: Jun Won KimDepartment of Psychiatry, Daegu Catholic University School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of KoreaTel +82-53-650-4332Fax +82-53-623-1694Email f_affection@naver.comPurpose: The excessive use of smartphones for social interaction is associated with mental health. However, few studies have considered the purpose of smartphone usage and screen time together. Therefore, we investigated the impact of smartphone purpose and screen time on mental health using data from the 2017 Korea Youth Risk Behavior Web-based Survey (KYRBS).Participants and Methods: A total of 54,243 adolescents answered items on purpose and screen time of smartphone use, stress perception, sleep dissatisfaction, depressive symptoms, and suicide-related indicators. The purpose of smartphone usage was categorized as social interaction and non-social interaction, and the daily smartphone screen time was classified into three categories: < 2 hours, ≥ 2 hours but < 4 hours, ≥ 4 hours per day.Results: We determined that, on weekdays, stress perception, sleep satisfaction, depressive symptoms, and suicide-related indicators worsened in both groups that used smartphones for ≥ 4 hours per day. When using smartphone for ≥ 2 hours but < 4 hours per day on weekdays, depending on the smartphone use purpose, mental health outcomes differed between the two groups. On weekends, using smartphones for ≥ 2 hours but < 4 hours per day worsened sleep satisfaction but decreased suicide-related indicators in both groups. Mental health outcomes improved when participants used smartphones for ≥ 2 hours but < 4 hours per day but worsened when smartphones were used for ≥ 4 hours per day on weekends.Conclusion: Recommended screen time of smartphone is different depending on the purpose of smartphone use, and the risk of uncontrolled usage is emphasized, rather than the absolute screen time.Keywords: mental health, smartphone addiction, social interaction, social media

ABCD4, a member of the ATP-binding cassette transporter superfamily, is associated with the transport of vitamin B12 which is crucial for the development of red blood cells (RBCs) and may also be involved in its metabolism. However, the molecular function of ABCD4 during RBC development in zebrafish is mostly unknown. Using a morpholino-based knockdown approach, we found that abcd4-knockdown resulted in abnormal RBCs of irregular shapes and various sizes. o-Dianisidine staining, as an indicator of hemoglobin in RBCs, further confirmed that abcd4 morphants possessed fewer hemoglobinized cells and impaired blood circulation. Multiple protein sequence alignment revealed that the amino acid sequence for residues 13-292, which is the domain of vitamin B12 transport, of the zebrafish Abcd4 was highly conserved compared to that of other species. Accordingly, the abcd4 morphants can be rescued with human ABCD4, demonstrating a conserved role of ABCD4 in vertebrates. Notably, the vitamin B12-deficient phenotype in abcd4 morphants, which causes anemia, was recapitulated in the newly-established abcd4 mutant, indicating the possibility that the abcd4 mutant could be used as a disease model of vitamin B12-deficiency anemia. Our study provides an insight that the analysis of the newly-established abcd4 mutant may contribute to understanding its roles in ABCD4-related vitamin B12-deficiency anemia and the associated pathogeneses in humans.

Objectives Anxiety disorders are the most common psychiatric disorders in adolescents and seem to occur the earliest among all forms of psychopathology. The aim of this study was to investigate the association of anxiety severity with health risk behaviors and mental health in adolescents. Methods Data from the 2020 Korean Youth Risk Behavior Web-Based Survey were analyzed. A total of 54948 adolescents responded to the 7-item Generalized Anxiety Disorder Scale (GAD-7) for the assessment of their anxiety severity as well as to the mental health and health risk behavior survey. Logistic regression analysis, t tests, and variance analysis of a complex sample general linear model were used to examine the association of anxiety severity with health behaviors and mental health. Results After statistical adjustment for sociodemographic characteristics, the subjects in the severe anxiety group were significantly more likely to be current smokers (odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.72-2.50), current drinkers (OR: 1.91, 95% CI: 1.67-2.19), experience habitual substance use (OR: 10.89, 95% CI: 8.22-14.42), have sexual intercourse (OR: 2.10, 95% CI: 1.76-2.51), and have unprotected intercourse (OR: 2.21, 95% CI: 1.67-2.92) than those in the normal group. Anxiety severity negatively correlated with sleep satisfaction and happiness, but positively correlated with stress perception, loneliness, depressive symptoms, and suicidality. Conclusion Adolescent anxiety is associated with health risk behaviors and poor mental health. Thus, early screening and intervention for anxiety in adolescents could contribute to the management and coping of youth health risk behaviors in the community.

Acupuncture is believed to improve ovarian reserve and reproductive outcomes in women undergoing in vitro fertilization (IVF). This study was conducted to evaluate the effect of network-optimized acupuncture followed by IVF on the oocyte yield in women showing a poor ovarian response. This study was an exploratory randomized controlled trial conducted from June 2017 to January 2020 at the Pusan National University Hospital. Women diagnosed with poor ovarian response were enrolled and randomly divided into two groups: IVF alone and Ac + IVF groups (16 acupuncture sessions before IVF treatment). Eight acupoints with high degree centrality and betweenness centrality were selected using network analysis. Among the participants, compared with the IVF treatment alone, the acupuncture + IVF treatment significantly increased the number of retrieved mature oocytes in women aged more than 37 years and in those undergoing more than one controlled ovarian hyperstimulation cycle. The negative correlation between the number of retrieved mature oocytes and consecutive controlled ovarian hyperstimulation cycles was not observed in the Ac + IVF group irrespective of the maternal age. These findings suggest that physicians can consider acupuncture for the treatment of women with poor ovarian response and aged > 37 years or undergoing multiple IVF cycles.

Center-of-pressure (CoP) measurements have been studied for assessing balance control. While CoP measurements using force plates have been used to assess standing balance in children with cerebral palsy (CP), it has not been assessed in a sitting position, which specifically reflects trunk postural control.The purpose of this study was to compare CoP measurements using force plates during both standing and sitting trials with the Pediatric Balance Scale (PBS) in children with spastic CP.We recruited 26 children with spastic CP (7.8 ± 3.4 years, 4-13 years) and used the PBS, a validated evaluation tool that measures static and dynamic balance control. We took CoP measurements using force plates during sitting and standing. For both trials, subjects stayed still for 10 s with their eyes open or closed. We calculated the CoP velocity, mediolateral (ML) and anteroposterior (AP) velocity, and ML and AP displacements of CoP.During standing trials, static PBS standing scores negatively correlated with more AP displacement and velocity than ML displacement and velocity (p 0.05). During sitting trials, dynamic PBS sitting scores negatively correlated with ML displacement and velocity (p 0.05). CoP parameters in the ML direction of the sitting position and CoP parameters in the AP direction of the standing position may better reflect the balance control in children with spastic CP.

Background The number of deaths from COVID-19 continues to surge worldwide. In particular, if a patient’s condition is sufficiently severe to require invasive ventilation, it is more likely to lead to death than to recovery. Objective The goal of our study was to analyze the factors related to COVID-19 severity in patients and to develop an artificial intelligence (AI) model to predict the severity of COVID-19 at an early stage. Methods We developed an AI model that predicts severity based on data from 5601 COVID-19 patients from all national and regional hospitals across South Korea as of April 2020. The clinical severity of COVID-19 was divided into two categories: low and high severity. The condition of patients in the low-severity group corresponded to no limit of activity, oxygen support with nasal prong or facial mask, and noninvasive ventilation. The condition of patients in the high-severity group corresponded to invasive ventilation, multi-organ failure with extracorporeal membrane oxygenation required, and death. For the AI model input, we used 37 variables from the medical records, including basic patient information, a physical index, initial examination findings, clinical findings, comorbid diseases, and general blood test results at an early stage. Feature importance analysis was performed with AdaBoost, random forest, and eXtreme Gradient Boosting (XGBoost); the AI model for predicting COVID-19 severity among patients was developed with a 5-layer deep neural network (DNN) with the 20 most important features, which were selected based on ranked feature importance analysis of 37 features from the comprehensive data set. The selection procedure was performed using sensitivity, specificity, accuracy, balanced accuracy, and area under the curve (AUC). Results We found that age was the most important factor for predicting disease severity, followed by lymphocyte level, platelet count, and shortness of breath or dyspnea. Our proposed 5-layer DNN with the 20 most important features provided high sensitivity (90.2%), specificity (90.4%), accuracy (90.4%), balanced accuracy (90.3%), and AUC (0.96). Conclusions Our proposed AI model with the selected features was able to predict the severity of COVID-19 accurately. We also made a web application so that anyone can access the model. We believe that sharing the AI model with the public will be helpful in validating and improving its performance.

MicroRNAs are a class of small, non-coding RNAs that play a key role in several biological and molecular processes, including tumorigenesis. We previously identified that MIR452 is upregulated in both colorectal cancer (CRC) and colitis. However, the functional mechanisms of MIR452 and its target genes in CRC and colitis are not well understood. So, we hypothesize that MIR452 can influence CRC and DSS-induced colitis model through the regulation of IL20RA and its downstream JAK-STATs signaling pathway. We used a luciferase reporter assay to confirm the effect of MIR452 on IL20RA expression. The protein and mRNA expression of a target gene and its associated molecules were measured by western blot, quantitative RT-PCR, and immunohistochemistry. We found that the IL20RA was a direct target gene of MIR452. Overexpression of MIR452 in CRC cell lines significantly decreased IL20RA and its downstream Janus kinase 1 (JAK1), Signal transducer and activator of transcription 1 (STAT1) and STAT3. Knockdown of IL20RA in CRC cell lines by IL20RA gene silencing also decreased the expression of IL20RA, JAK1, and STAT3, but not of STAT1. Our results suggest that MIR452 regulates STAT3 through the IL20RA-mediated JAK1 pathway, but not STAT1. Overall, MIR452 acts as tumor suppressor in human CRC and in a mouse colitis model. These findings suggest that MIR452 is a promising therapeutic target in the treatment of cancer and colitis.

This review aimed to investigate the efficacy of integrative medicine (herbal medicine combined with drug therapy) in the treatment of Behcet’s disease (BD). Eleven databases were searched from their inception to 7 December 2020, for randomized control trials (RCTs) that reported the effects of integrative medicine in treating BD. The risk of bias was assessed using seven domain criteria from the Cochrane Collaboration tool. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence. The direction of the effect is also shown in the form of an albatross plot. Sixteen trials met the inclusion criteria and were analyzed. The overall risk of bias was determined to be uncertain. The meta-analysis showed a superior response rate with herbal medicine plus drug therapy (relative risk (RR) 1.19, 95% confidence interval (CI) 1.13 to 1.25, n = 1034, p < 0.00001, I2 = 0%, low certainty of evidence (CoE)) compared to drug therapy. Integrative medicine also lowered the recurrence rate after 2 months of follow-up (RR 0.27, 95% CI 0.09 to 0.76, n = 120, p = 0.01, I2 = 0%, low CoE). The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and skin lesions were also significantly improved using integrative medicine, but equivalent effects were seen for oral ulcers, genital ulcers, and eye inflammation. Minor adverse events were reported in both groups. Our findings suggest that herbal medicine combined with drug therapy is more effective for the treatment of BD than drug therapy alone. Although the type of drug therapy used varied across the studies, integrative medicine was shown to improve the total response rate, skin lesions, the ESR, and the CRP level. However, the overall risk of bias of the studies was concerning, and the CoE was low. Information on adverse events (AEs) was also insufficient. In addition, the number of studies included for data synthesis for most outcomes was small. Future studies with rigorous RCTs may help establish the efficacy of integrative medicine in the treatment of BD.

BackgroundThe purpose of this study was to identify the attitude of South Korean medical school students towards psychiatry and to analyze how lectures and clinical clerkship in psychiatry effect changes in students’ attitudes. MethodsA total of 100 medical school students were recruited as subjects in the study, 86 of whom completed psychiatry lectures and underwent psychiatry clerkship from March 2015 to August 2018. The participating students completed a survey, which included demographic data, specialty choice, and attitude towards psychiatry. ResultsSubjects who completed lectures and clinical clerkship in psychiatry showed positive changes in attitude towards psychiatry in the following items: “Among mental health professionals, psychiatrists have the most authority and influence” (p=0.002), “Psychiatrists frequently abuse their legal power to hospitalize patients against their will” (pConclusionAfter each curriculum, certain attitudes toward psychiatry were positively changed, but others either remained unchanged or were negatively changed. By using these study results to revise the current curriculum, medical school students’ attitude towards psychiatry can be improved.

This study investigated quantitative electroencephalography (QEEG) subtypes as auxiliary tools to assess Attention Deficit Hyperactivity Disorder (ADHD). A total of 74 subjects (58 male and 16 female) were assessed using the Korean version of the Diagnostic Interview Schedule for Children Version IV and were assigned to one of three groups: ADHD, ADHD-Not Otherwise specified (NOS), and Neurotypical (NT). We measured absolute and relative EEG power in 19 channels and conducted an auditory continuous performance test. We analyzed QEEG according to the frequency range: delta (1–4 Hz), theta (4–8 Hz), slow alpha (8–10 Hz), fast alpha (10–13.5 Hz), and beta (13.5–30 Hz). The subjects were then grouped by Ward’s method of cluster analysis using the squared Euclidian distance to measure dissimilarities. We discovered four QEEG clusters, which were characterized by: (a) elevated delta power with less theta activity, (b) elevated slow alpha relative power, (c) elevated theta with deficiencies of alpha and beta relative power, and (d) elevated fast alpha and beta absolute power. The largest proportion of participants in clusters (a) and (c) were from the ADHD group (48% and 47%, respectively). Conversely, group (b) mostly consisted of the participants from the NOS group (59%), while group (d) had the largest proportion of participants from the NT group (62%). These results indicate that children with ADHD does not neurophysiologically constitute a homogenous group. We also identified a new subtype with increased alpha power in addition to those commonly reported in ADHD. Given the QEEG characteristics with increased alpha power, we should consider the possibility that this subtype may be caused by childhood depression. In conclusion, we believe that these QEEG subtypes of ADHD are expected to provide valuable information for accurately diagnosing ADHD.

The Research Domain Criteria (RDoC) project was proposed by the National Institute of Mental Health in 2010 to create a new diagnostic system including symptoms and data from genetics, neuroscience, physiology, and self-reports. The purpose of this study was to determine the link between anxiety and executive functions through quantitative electroencephalography (qEEG) based on the RDoC system. Nineteen-channel EEGs were recorded at the psychiatric clinic from 41 patients with symptoms of anxiety. The EEG power spectra were analysed. The Executive Intelligence Test (EXIT) including the K-WAIS-IV, Stroop, controlled oral word association, and the design fluency tests were performed. A partial, inversed, and significant association was observed between executive intelligence quotient (EIQ) and the absolute delta power in the central region. Similarly, a partial, inversed, and significant association was observed between design fluency and the absolute delta power in the left parietal area. Our findings suggest that the increase in delta power in the central region and left P3 was negatively correlated with the decrease in executive function. It is expected that the absolute delta power plays a specific role in the task-negative default mode network in the relationship between anxiety and executive function.

Geun Hui Won, Tae Young Choi, Jun Won Kim Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of KoreaCorrespondence: Jun Won KimDepartment of Psychiatry, Catholic University of Daegu School of Medicine, 3056-6 Daemyeong-4 Dong, Nam-gu, Daegu 705-718, Republic of KoreaTel +82 53 650 4332Fax +82 53 623 1694Email f_affection@naver.comPurpose: We aimed to compare the Korean version of the ADHD Rating Scale (K-ARS) and Integrated Visual and Auditory Plus (IVA+Plus), a continuous performance test, by analyzing their abilities to distinguish different groups (attention-deficit/hyperactivity disorder [ADHD], ADHD-not otherwise specified [NOS], and normal control [NC]).Patients and Methods: Individuals of 7– 12 years of age who visited our child and adolescent psychiatric clinic were recruited. Seventy-four participants (58 males, 16 females) were classified into three groups according to results from the Korean Version of Diagnostic Interview Schedule for Children Version IV. The K-ARS and IVA+Plus were administered. An analysis of covariance (ANCOVA) was conducted. The tools’ accuracy in discriminating patients with ADHD or NOS from NCs was evaluated using a receiver operating characteristic (ROC) curve analysis.Results: ANCOVA revealed significant differences in the K-ARS results of the three groups (ADHD [n=29], NOS [n=33], NC [n=12]), whereas a difference in IVA+Plus results was observed only between the ADHD and NC groups. In the ROC curve analysis of the K-ARS, the areas under the curve (AUCs) for each group were 0.960 (ADHD vs NC), 0.885 (NOS vs NC), 0.920 (ADHD+NOS vs NC), and 0.779 (ADHD vs NOS+NC). In the ROC curve analysis for the IVA+Plus hyperactivity-impulsiveness scale, the AUCs for each group were 0.740 (ADHD vs NC), 0.643 (NOS vs NC), 0.688 (ADHD+NOS vs NC), and 0.626 (ADHD vs NOS+NC); those for the inattention scale were 0.731 (ADHD vs NC), 0.658 (NOS vs NC), 0.692 (ADHD+NOS vs NC), and 0.625 (ADHD+NOS vs NC).Conclusion: The K-ARS was useful to distinguish the ADHD and NOS groups from the NC group, while the IVA+Plus was useful to distinguish the ADHD group from the NC group. Clinicians should ensure they understand the properties of each tool and apply them appropriately in the diagnosis of ADHD.Keywords: diagnostic accuracy, patient assessment, hyperactivity-impulsiveness scale, inattention scale

Background: There is worldwide interest in the mental health of firefighters, since they are more prone to exposure to traumatic stress and psychiatric disorders. Aims: This study aimed to assess their mental health and provide individualized support to local firefighters through a mental health promotion program. Method: Eighteen hundred and fifty-nine active Korean firefighters in 2015 and 2017 (502 and 1,357, respectively) participated in the ‘Visiting Counselling Centre for Firefighters’ program commissioned by the National Fire Agency. The program consisted of self-administered questionnaires, a group education session, an individual counseling session for every participant, four counseling sessions for certain participants and additional brief intensive counseling (BIC). We administered the Post-traumatic stress disorder Checklist (PCL), Beck’s Depression Inventory (BDI), Beck’s Anxiety Inventory (BAI), Beck Scale for Suicidal ideation (BSS), Insomnia Severity Index (ISI), Korean version of the Alcohol Use Disorders Identification Test (AUDIT-K) and the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) before and after the program. Additional analysis was performed to determine whether BIC participation further improved the psychopathological outcome. Results: The participants showed meaningful improvement in all psychopathological scales; the PCL, BDI, BAI, BSS, ISI, AUDIT-K and WHOQOL-BREF scores all significantly improved. Meanwhile, BIC participation improved certain psychopathological symptoms at a higher degree; the BDI, BAI, BSS and AUDIT-K scores significantly improved. Conclusion: The mental health promotion program improved the mental health of the participating active firefighters in Korea. Meanwhile, BIC participation improved certain psychopathological symptoms at a higher degree. A comprehensive approach for supporting the mental health of firefighters should be considered.

Cephalopods have the most advanced nervous systems and intelligent behavior among all invertebrates. Their brains provide comparative insights for understanding the molecular and functional origins of the human brain. Although brain maps that contain information on the organization of each subregion are necessary for a study on the brain, no whole brain atlas for adult cephalopods has been constructed to date. Here, we obtained sagittal and coronal sections covering the entire brain of adult Octopus minor (Sasaki), which belongs to the genus with the most species in the class Cephalopoda and is commercially available in East Asia throughout the year. Sections were stained using Hematoxylin and Eosin (H&E) to visualize the cellular nuclei and subregions. H&E images of the serial sections were obtained at 30~70-µm intervals for the sagittal plain and at 40~80-µm intervals for the coronal plain. Setting the midline point of the posterior end as the fiducial point, we also established the distance coordinates of each image. We found that the brain had the typical brain structure of the Octopodiformes. A number of subregions were discriminated by a Hematoxylin-positive layer, the thickness and neuronal distribution pattern of which varied markedly depending upon the region. We identified more than 70 sub-regions based on delineations of representative H&E images. This is the first brain atlas, not only for an Octopodiformes species but also among adult cephalopods, and we anticipate that this atlas will provide a valuable resource for comparative neuroscience research., Graphical Abstract

Introduction. Pharmacoacupuncture is a new acupuncture treatment that stimulates acupuncture points by injecting herbal medicine into them. Recently, pharmacoacupuncture has been widely used in the treatment of idiopathic Parkinson’s disease in traditional East Asian medicine. The purpose of this systematic review is to evaluate the efficacy and safety of pharmacoacupuncture in the treatment of idiopathic Parkinson’s disease. Methods. The following electronic databases were searched for studies published in or before December 2016: Medline, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, OASIS, and CNKI, without language restriction. The main outcome assessed was the total Unified Parkinson’s Disease Rating Scale (UPDRS) score. The details of the pharmacoacupuncture intervention, such as the herbal medicine and acupuncture points used, were also investigated. Results. From 138 studies, 3 randomized controlled trials were included; the number of patients analyzed was 134. Most of the studies showed considerable methodological flaws. There was heterogeneity of the intervention type and treatment duration in the included studies. Therefore, we could not conduct a meta-analysis. In one study, adjunctive bee venom pharmacoacupuncture therapy significantly improved total UPDRS scores compared with conventional therapy alone. Another study, which used adjunctive Kakkonein pharmacoacupuncture, did not reveal significant improvement compared with conventional therapy alone. A third study reported that Mailuoning pharmacoacupuncture was able to significantly improve the modified Webster Symptom Score when compared with no treatment. Adverse events related to the pharmacoacupuncture were reported in only one case, itching caused by the bee venom. Conclusions. Our findings regarding the efficacy of pharmacoacupuncture as a therapy for idiopathic Parkinson’s disease are currently inconclusive. Further large and rigorous clinical trials are needed.

Summary Introduction Fatty liver disease (FLD) is correlated with cardiovascular disease. Carotid intima–media thickness (CIMT) and coronary artery calcium score (CACS) can noninvasively identify subclinical atherosclerosis and predict risk for cardiovascular events. This study evaluated CIMT and CACS measurements to detect subclinical atherosclerosis in patients with and without FLD. Methods Patients who underwent carotid and abdominal ultrasounds as well as cardiac computed tomography (CT) scans were evaluated retrospectively. The differences between the mean CIMT value and CACS measurements in patients with FLD and those with normal livers were estimated. Results Among 819 patients (average age of 53.3 ± 11.2 years), 330 had FLD. The CIMT was greater in patients with FLD compared to the controls (0.79 ± 0.17 vs 0.76 ± 0.17 mm, p = 0.012), and carotid plaques were more commonly seen in patients with FLD. The incidence of a composite of larger CIMT (≥ 75th percentile) plus plaque presence was higher in FLD patients (43.3 vs 36.0%, p = 0.041). Particularly among young patients (≤ 50), the CIMT was larger in patients with FLD than in the controls. FLD increased the risk of a composite of large CIMT plus plaque presence in young patients (odds ratio 1.92, 95% confidence interval 1.05–3.49, p = 0.034). However, patients with FLD had no greater incidence of CACS of over 100 than the controls. Conclusion CIMT was a better marker of underlying subclinical atherosclerotic risk among patients with FLD than CACS. FLD particularly, increases the risk of subclinical atherosclerosis in patients younger than 50 years of age. These patients should undergo screening CIMT to detect atherosclerosis and modify risk factors.

Background The demand for anti-melanogenic agents is increasing due to the unwanted side effects of current treatments. To find an effective anti-melanogenic agent, we used zebrafish as a whole animal model for phenotype-based drug and cosmetic discovery screening. Objectives The aim of this study was to identify and explore a small molecule that could be used for skin-whitening cosmetics. Methods Using zebrafish embryos, we examined the effects of 1000 compounds on zebrafish development and pigmentation. Pigmentation production was assessed by tyrosinase (TYR) enzymatic activity and melanin contents. Pigmentation marker expression in the human melanoma cell line HMV-II was analyzed by western blot. We also tested reconstituted human skin tissue and analyzed KDZ-001 with computational molecular modeling. Results We identified three compounds that affected the pigmentation of developing melanophores in zebrafish. Among them, we identified KDZ-001, a novel anti-melanogenic agent, which strongly inhibits melanin synthesis in the developing melanophores of zebrafish, HMV-II cells, and reconstituted human skin with no toxicity. We found that KDZ-001 directly inhibits TYR enzymatic activity. Notably, computational molecular modeling of KDZ-001 suggested that its interaction with copper ions in the active site of TYR is essential for melanin synthesis, further demonstrating that KDZ-001 mainly acts as a TYR inhibitor to synthesize melanin. Conclusion KDZ-001 inhibits melanin synthesis and has a potential for use in skin-whitening cosmetics.

Introduction This study aimed to investigate the perception of Korean medicine (KM) doctors regarding the treatment of degenerative lumbar spinal stenosis (LSS) and explore their opinions on the core clinical questions (CQs) of KM clinical practice guidelines (CPGs) for patients with degenerative LSS. Methods An online cross-sectional survey distributed via e-mail was conducted in December 2016. The study population included registered KM doctors (KMDs) in South Korea. The e-mail contained 13 questionnaire items regarding the doctors’ demographic characteristics and perceptions of the core CQs that should be addressed in CPGs for patients with degenerative LSS. Descriptive analyses were performed to summarize the data. Results A total of 680 KMDs responded to the survey. Kidney qi deficiency was the most commonly used diagnostic name for degenerative LSS. Acupuncture ranked first in the treatment used for degenerative LSS and in the treatment desired to be included in the development of CPG recommendations. Ojeok-san (积散, 積散, Wuji-san, Goshaku-san) was the number one herbal medicine, and 5% bee venom pharmacopuncture was the number one pharmacopuncture technique used for degenerative LSS. Drug therapy was the most selected control treatment considered appropriate to assess treatment effectiveness and safety. Pain relief was the most chosen indicator among the indicators considered reasonable to assess therapeutic effectiveness. Conclusion Results of this study are expected to inform the development of key CQs of the KM standard CPG for degenerative LSS. The involvement of KMDs in the CPG development process can help develop useful and available CPGs.

Background This study aimed to obtain the symptom, prescription and therapeutic patterns for the treatment of patients with menopausal syndrome in major Korean medicine (KM) hospitals. Methods We used a retrospective chart review of climacteric disorder and postmenopausal syndrome patients by examining medical records (ICD-10, menopausal and female climacteric states: N95.1, Menopausal and perimenopausal disorder, unspecified: N95.9) from eight university KM hospitals in South Korea. Results The main symptoms of 1,682 patients with menopausal disorders visiting 8 college-affiliated oriental medicine hospitals were hot flush, hyperhidrosis, fatigue, insomnia, and chest tightness. Guipi-tang (decoction), Siwu Guipi-tang (decoction), Qingxin Lianzi-yin (decoction), Jiawei Xiaoyao-san (powder) and Guipi Wendan-tang (decoction) were the most commonly prescribed herbal medicines for menopausal disorders. Patients were most often treated with a combination of herbal medicine and acupuncture. Conclusion Our study shows that the current prescribed herbal medicines were used for treating menopausal disorders in Korean medicine hospitals. However, the objectivity of the efficacy assessment should be studied further.

Summary Background: Following femur fracture, medullary fat enters the systemic circulation and altered pulmonary haemodynamics may contribute to pulmonary complications. This study evaluated the association between right ventricular (RV) function and pulmonary complications in patients with femur fracture. Methods: Patients with a femur fracture who had undergone pre-operative echocardiography that included RV peak global longitudinal strain (RV GLS) were evaluated retrospectively between March 2015 and February 2016. Pulmonary complications were defined as the development of pneumonia or pulmonary thromboembolism during the first postoperative month. Results: Among 78 patients, pulmonary complications developed in eight (10.3%). The RV GLS value of all patients was lower than the normal range. In addition, the RV GLS value of patients with pulmonary complications was significantly lower than that of patients without pulmonary complications. Multivariate regression analyses found that worse RV GLS values independently predicted pulmonary complications [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.047–4.151, p = 0.037]. Receiver operating characteristic curve analysis found that a RV GLS value of –14.85% was the best cut-off value to predict pulmonary complications; sensitivity: 75.0%; specificity: 62.9%. Moreover, patients with RV GLS values > –14.85% had significantly lower pulmonary complication-free survival. Conclusions: In patients with femur fracture, RV GLS values could help predict pulmonary complications. Therefore, patients with RV GLS values > –14.85 should be monitored closely before and after surgery for femur fracture.

Upon mild liver injury, new hepatocytes originate from pre-existing hepatocytes. However, if hepatocyte proliferation is impaired, a manifestation of severe liver injury, biliary epithelial cells (BECs) contribute to new hepatocytes through BEC dedifferentiation into liver progenitor cells (LPCs), also termed oval cells or hepatoblast-like cells (HB-LCs), and subsequent differentiation into hepatocytes. Despite the identification of several factors regulating BEC dedifferentiation and activation, little is known about factors involved in the regulation of LPC differentiation into hepatocytes during liver regeneration. Using a zebrafish model of near-complete hepatocyte ablation, we here show that Bmp signaling is required for BEC conversion to hepatocytes, particularly for LPC differentiation into hepatocytes. We found that severe liver injury led to the upregulation of genes involved in Bmp signaling, including smad5, tbx2b, and id2a, in the liver. Bmp suppression did not block BEC dedifferentiation into HB-LCs; however, the differentiation of HB-LCs into hepatocytes was impaired due to the maintenance of HB-LCs in an undifferentiated state. Later Bmp suppression did not affect HB-LC differentiation, but increased BEC number through proliferation. Notably, smad5, tbx2b, and id2a mutants exhibited similar liver regeneration defects as those observed in Bmp-suppressed livers. Moreover, BMP2 addition promoted the differentiation of a murine LPC cell line into hepatocytes in vitro. Conclusions: Bmp signaling regulates BEC-driven liver regeneration via smad5, tbx2b and id2a: it regulates HB-LC differentiation into hepatocytes via tbx2b and BEC proliferation via id2a. Our findings provide insights into promoting innate liver regeneration as a novel therapy. This article is protected by copyright. All rights reserved.

Introduction Moxibustion is the burning of mugwort used to stimulate acupuncture points on the skin. In traditional East-Asian medicine, moxibustion is often used as a non-drug treatment for idiopathic Parkinson's disease (IPD). The aim of this systematic review was to evaluate the effectiveness and safety of moxibustion therapy to treat IPD. Methods The following electronic databases were searched for studies published in or before December 2016: Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, OASIS (Korean database), and CNKI (Chinese database). Two researchers conducted the data extraction and risk of bias assessments. Results From the results, a total of 10 studies (644 IPD patients) were included in this review. Overall methodological quality was not high and all studies included small numbers of participants which could not ensure the rigor of the synthesized evidence. There was a considerable clinical heterogeneity in terms of patient’s population, moxibustion types and control group interventions. Compared with control group, moxibustion did not show significant difference in the overall effectiveness ratio (RR 1.20, 95% CI [1.00, 1.44]). About the total unified Parkinson’s disease rating scale (UPDRS) score, however, there was significant difference between moxibustion and control interventions (MD −8.75, 95% CI [−12.54, −4.95]). Adverse events related to moxibustion treatment were not reported in most of the studies. Conclusions Evidence on the benefit and harm of moxibustion therapy for IPD was not conclusive due to methodological problems and small sample sizes among the included studies. More rigorous clinical studies will be necessary in future.

Background Differences between the recently suggested outcome-driven diagnostic threshold of home blood pressure (HBP) measurements and the currently recommended diagnostic threshold of HBP measurements may cause a disagreement between 24-hour ambulatory blood pressure (ABP) and HBP measurements in the diagnosis of hypertension. We evaluated the agreement of various HBP diagnostic thresholds (135/85, 130/85, and 130/80 mm Hg) to ABP measurements, as a reference method. Methods Patients who were confirmed to have high BP (≥140/90 mm Hg) at the outpatient clinic were referred. HBP measurement was performed for 7 days in triplicates every morning and evening. The 24-hour ABP measurement was performed on the 8th day. Using 24-hour ABP measurement as a reference method, we analyzed HBP diagnostic thresholds at 135/85, 130/85, and 130/80 mm Hg. Results Among 319 patients, 256 patients (mean age, 51.8 ± 9.7 years; 119 men) with valid HBP measurements and 24-hour ABP measurements were enrolled. The threshold of 130/80 mm Hg showed the highest diagnostic sensitivity (P = 0.001) with diagnostic agreement by Kappa statistics. Using 130/80 mm Hg as a diagnostic threshold of hypertension, the prevalence of masked hypertension was significantly lower than 130/85 and 135/85 mm Hg (7.8, 15.2, and 18.4%, respectively, P = 0.002). Conclusions The present study suggests that lowering the diagnostic thresholds of HBP measurement from 135/85 mm Hg to 130/80 mm Hg may improve diagnostic accuracy for hypertension.

The liver has a highly regenerative capacity. In the normal liver, hepatocytes proliferate to restore lost liver mass. However, when hepatocyte proliferation is impaired, biliary epithelial cells (BECs) activate and contribute to hepatocytes. We previously reported in zebrafish that upon severe hepatocyte ablation, BECs extensively contribute to regenerated hepatocytes. It was also speculated that BEC-driven liver regeneration might occur in another zebrafish liver injury model in which temporary knockdown of the mitochondrial import gene tomm22 by morpholino antisense oligonucleotides (MO) induces hepatocyte death. Given the importance of multiple BEC-driven liver regeneration models for better elucidating the mechanisms underlying innate liver regeneration in the diseased liver, we hypothesized that BECs would contribute to hepatocytes in tomm22 MO-injected larvae. In this MO-based liver injury model, by tracing the lineage of BECs, we found that BECs significantly contributed to hepatocytes. Moreover, we found that surviving, preexisting hepatocytes become BEC‐hepatocyte hybrid cells in tomm22 MO-injected larvae. Intriguingly, both the inhibition of Wnt/β-catenin signaling and macrophage ablation suppressed the formation of the hybrid hepatocytes. This new liver injury model in which both hepatocytes and BECs contribute to regenerated hepatocytes will aid in better understanding the mechanisms of innate liver regeneration in the diseased liver.

Introduction Based on a structured, rigorous methodology developed for creating evidence-based clinical practice guidelines (CPGs), the Korean Institute of Oriental Medicine and Korean Acupuncture and Moxibustion Medicine Society developed a guideline for treating acute ankle sprain using acupuncture which is part of Korean medicine (KM). Methods Using a revised Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, the committee based these recommendations on a systematic review of randomized controlled trials on any form of acupuncture used for ankle sprains published up to July 2015. Accessible sources relating to ankle sprain were collected, and a systematic review and meta-analysis were applied to the collected data. The quality of evidence was graded, and the recommendations were drafted and then finalized after official approval. Results For this CPG, six clinical questions and recommendations that were primarily related to manual acupuncture methods were addressed. Four were related to manual acupuncture alone, of which one focused on electroacupuncture and another on pharmacopuncture. Clinical outcomes evaluated were pain reduction using a visual analogue scale (VAS) or the numeric rating scale and improved cure rates, joint position sense, kinesthesia, and range of motion. Manual acupuncture was thus recommended as grade A treatment for alleviating VAS-graded pain. Conclusions The guideline for treating ankle sprain establishes a standard procedure to ensure high-quality medical care for ankle sprain that could be applied globally to patients seeking KM. It also supports international traditional medicine research methodology. When further clinical research is conducted, this CPG can be updated, adding value to its content.

The aim of this study was to update previous reviews and examine recent evidence from randomised clinical trials (RCTs) of the use of moxibustion for osteoarthritis (OA). Twelve databases were searched from inception through to September 2016 with no language limits applied. Data extraction and risk-of-bias assessments were performed by two independent reviewers. A total of 19 RCTs met all inclusion criteria and were evaluated. Three RCTs compared the effects of moxibustion with those of sham moxibustion in patients with knee OA (KOA) and found favourable effects of moxibustion on pain reduction (n=305; SMD, -0.46; 95% CI: -0.86 to -0.06, P=0.02, I2=65%), including at follow-up (n=305; SMD, -0.36; 95% CI: -0.70 to -0.01, P=0.04, I2=54%). Eleven RCTs compared the effects of moxibustion with those of conventional oral drug therapies. Eight RCTs reported a total symptom score and the meta-analysis showed superior effects of moxibustion compared with drug therapies for this measure (n=691; SMD, -0.24; 95% CI: -0.78 to 0.29; P=0.37, I2=91%) and response rate (n=758 knees; RR, 1.10; 95% CI: 1.05-1.16, P

Introduction Nourishing yin is one of the most important treatment methods for skin diseases. The main conditions for which herbal prescriptions are used for nourishing yin are: skin pruritus, psoriasis, eczema, atopy, acne and alopecia. The aim of this systematic review was to identify and analyse trial data on the efficacy and safety of the nourishing yin method using herbal medicine for skin disease. Methods Eleven electronic databases were searched from their inception through until December 2016, with no language limitation. Randomised controlled trials for nourishing yin using herbal prescriptions used to treat skin disease were identified and their risk of bias of assessed. Results Of 725 of the total trials identified, 29 studies were included. Most studies had a high risk of bias. Twenty-five RCTs tested nourishing yin herbal medicines for various skin diseases compared with conventional medicines. Most showed superior response rates compared with conventional medicine, and 7 trials reported equivalent effects. The meta-analysis showed favourable effects of the nourishing yin method using herbal medicine for various skin diseases (n = 2813, RR: 1.20, 95% CI: 1.13 to 1.26, P Conclusion This review provides superior or equivalent effects of the nourishing yin method using herbal prescriptions for treating skin diseases compared with conventional medicines.

Objective The aim of the present study was to evaluate the role of comorbid psychiatric symptoms on quantitative electroencephalogram (QEEG) activities in boys with the attention deficit/hyperactivity disorder (ADHD). Methods All participants were male students in the second, third or fourth grade in elementary school. Therefore, there were no significant differences in age or sex. Participants with ADHD were assigned to one of three groups: pure ADHD (n=22), ADHD with depressive symptoms (n=11), or ADHD with problematic internet use (n=19). The Korean version of the Children's Depression Inventory and the Korean Internet Addiction Self-scale were used to assess depressive symptoms and problematic internet use, respectively. Resting-state EEG during eyes closed was recorded, and the absolute power of five frequency bands was analyzed: delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12-30 Hz), and gamma (30-50 Hz). Results The ADHD with problematic internet use group showed decreased absolute theta power at the central and posterior region compared with the pure ADHD group. However, The ADHD with depressive symptoms group showed no significant differences compared with the other groups. Conclusion These findings will contribute to a better understanding of brain-based electrophysiological changes in children with ADHD in accordance with comorbid psychiatric symptoms.

Introduction Shoulder pain is a common musculoskeletal problem and one of the highest health expenditures in Korea. This article describes the development of evidence-based Korean medicine (KM) clinical practice guidelines (CPGs) for manual acupuncture for the management of shoulder pain. Methods The CPG-KM Development Committee was provided with 12 clinical questions on manual acupuncture for the management of shoulder pain. A literature search was then conducted on seven databases (PubMed, Medline, the Cochrane Library, three Korean medical databases and one Chinese medical database). Results The final recommendations were developed by reaching official agreement on the draft using the Delphi method and the CPG-KM for shoulder pain which was approved by The Society of Korean Medicine Rehabilitation. Twelve clinical questions and eleven of the recommendations (grade A (2), B (5), C (2) and GPP (2)) were primarily related to manual acupuncture methods. A manual acupuncture treatment is recommended as grade A, to alleviate pain and improve the range of motion and shoulder joint function of an adult shoulder pain patient. An acupuncture treatment for shoulder pain should simultaneously consider local and distal acupoints. Conclusion The CPG KM for shoulder pain provides a standard procedure for the treatment process to ensure that a high quality medical service is provided globally to all patients for traditional KM, thereby supporting international traditional medicine research methodology. If additional clinical research is conducted in the future, this CPG can be updated to reflect the most up-to-date evidence.

Background The aim of this study was to investigate the clinical practice of Korean medicine doctors (KMDs) for managing menopausal disorders. Methods We conducted a web-based questionnaire for KMDs to respond to recommendations across the three main KM domains: major symptoms of menopausal disorders, herbal prescriptions, and pattern identification. Results We received responses from 227 doctors who have treated menopausal disorders. The major pattern identifications recommended by the doctors for the pre-, peri-, and postmenopausal phases, respectively, were depression of liver energy (59.5%), kidney yin deficiency (49.8%), and kidney yin deficiency (50.7%). The most frequent herbal remedies prescribed for the pre-, peri-, and postmenopausal phases were Jiawei shaoyao-san (58.1%), Jiawei shaoyao-san (48.5%), and Jiawei guipi-decoction (37.9%), respectively. Conclusion The results of our clinical practice survey provide information on KMDs’ clinical experiences of using herbal medicines and their use of pattern identification to manage menopausal disorders.

Background This survey aimed to investigate clinicians’ perceptions and current practice patterns of Korean medicine (KM) treatment for female infertility. Methods A questionnaire on clinical practice patterns of KM treatment for female infertility was constructed and distributed to 703 KM doctors (KMDs). Results A total of 20.5% of physicians (n = 144/703) completed the survey and delivered integrative care for female infertility patients. Integrative care mainly consisted of acupuncture, herbal medicine, and moxibustion. The participants largely relied on radiological findings on ultrasonography and hormone tests for diagnosis. The most frequently prescribed herbal medication was Jogyeongjongok-tang (Tiaojing Zhongyu decoction), and the most frequently applied acupoints were SP6, CV4 and ST36. Conclusions This study provides expert opinions and information on actual clinical practice patterns of KM for treating female infertility. However, we cannot completely discount the possibility that biased selection of subjects and the low response rate limit the interpretations of the study results.

Background: Most women experiencing menopause have sought out traditional treatment options to relieve their symptoms. The aim of this study, which used a web-based survey, was to investigate perceptions of Korean medicine doctors (KMDs) on managing menopausal symptoms with herbal medicines. Methods: We developed and then sent a questionnaire via email to a total 497 KMDs in obstetrics and gynecology affiliated with the Society of Korean Medicine. The questionnaire consisted of three categories and a total of 26 items focusing on major menopausal symptoms, prescriptions, pattern identification, and background characteristics. Results: Out of the 497 KMDs, we received responses from 48 doctors, a response rate of 9.7%. The most common symptoms of menopausal disorder perceived by responded KMDs were hot flashes (22.9%), sleep disorders (18.2%), systemic fatigue (12.5%), and sweating (12.0%). The herbal medicines reported to be the most effective when treating patients with menopausal disorders were Jiawei shaoyao-san (12.5%), Jiawei guipi-decoction (11.8%). The responding KMDs recommended one to two months of treatment for female menopausal disorder, using two to three doses of herbal medicine per day in combination with traditional Korean medicine (KM) therapies such as acupuncture, moxibustion, cupping, and pharmacopuncture. Conclusion: The results of this survey may provide information about doctor’s perceptions on using herbal medicines to manage patient’s menopausal symptoms. Future studies should be done with a larger sample size to overcome the limitation of this study and to examine how KM is used for treating menopausal symptoms in clinical practice. Keywords: Menopausal symptoms, Herbal medicines, Web-based survey

Introduction Evidence based clinical practice guidelines (EB-CPGs) are recommended in order to improve the quality of healthcare. The objective of this study was to assess whether providing an EB-CPG leaflet improved the level of satisfaction of patients with shoulder pain. Methods A randomized crossover study was conducted in Gwangju Korean Medicine Hospital of Wonkwang University. Fifty participants were randomly assigned to one of two different sequences – Sequence 1: Korean medicine (KM) treatment with EB-CPG leaflet – without- EB-CPG leaflet or Sequence 2: KM treatment without EB-CPG leaflet – with EB-CPG leaflet. The washout period between the two methods was two weeks. The main outcome was patient satisfaction throughout the treatment procedure (scored on a 5-point Likert scale) that had five items: satisfaction with the KM doctor's (KMD's) explanation, understanding of the KMD's explanation, improvement in the reliability of KM, satisfaction with the treatment time, and overall satisfaction. Results The results indicated that KM treatment with the EB-CPG leaflet had a considerably greater impact in patient improvement than KM treatment with no leaflet on total patient satisfaction (P = 0.026). Patients perceived ‘reliability of KM treatments’ was higher in the KM treatment with a leaflet than in the treatment group with no leaflet (P = 0.0004). Conclusion Despite this short-term intervention, KM treatment with a leaflet that included EB-CPG information was shown to be an effective method of communication for patients being treated for shoulder pain. The efficiency of this EB-CPG-based communication tool should be further explored.

Introduction Lumbar herniated intervertebral disc (HIVD) is a common chronic disease, and in Korea many patients use Korean medicine (KM) for treatment. However, KM clinical practice guideline (CPG) for HIVD remain poor. Therefore, this aim is to describe the KM approach for managing HIVD in Korea from an evidence-based medicine (EBM) perspective. Methods A systematic review was undertaken of literature focusing on key areas of KM practice aimed at managing HIVD. The evidence obtained was based on the study design and the risk of bias. Recommendations were formulated, taking the quality, quantity, and level of the evidence into consideration, as well as the likely clinical impact and the applicability of the evidence to KM practice in Korea. Preliminary CPGs were then recommended for the application of KM for the management of HIVD. After several rounds of expert consensus meetings, the final guideline was endorsed by relevant professional committees. Results The final recommendation was made based on a draft of the recommendations of the working group during the consensus process. A total of 15 recommendation statements were made regarding KM treatments for HIVD, which included acupuncture (n = 3), pharmacopuncture (n = 3), herbal medicine (n = 3), chuna (n = 2), moxibustion (n = 2), and cupping therapy (n = 2). Conclusions Following on from the above development, we sought to carry out a high-quality follow-up KM clinical study with the objective of improving HIVD patients understanding of medical treatments for the condition. Also, future research in this area will formally examine the success of the guideline’s implementation.

Aim We compared the efficacy of bupropion and escitalopram treatments in Internet gaming disorder (IGD) patients. Methods We recruited 119 adolescents and adults with IGD. We treated these participants for 6 weeks in three groups as follows: 44 participants were treated with bupropion SR (bupropion group), 42 participants were treated with escitalopram (escitalopram group), and 33 patients without any medication were observed in the community (observation group). At baseline and at the 6-week follow-up visit, all subjects were evaluated using the Clinical Global Impression-Severity Scale, the Young Internet Addiction Scale, the Beck Depression Inventory, the ADHD Rating Scale, and the Behavioral Inhibition and Activation Scales. Results Both the escitalopram group and the bupropion group showed improvement on all clinical symptom scales after 6 weeks of treatment compared to the observation group. Additionally, the bupropion group showed greater improvement on scores for the Clinical Global Impression-Severity Scale, the Young Internet Addiction Scale, the ADHD Rating Scale, and the Behavioral Inhibition Scale than the escitalopram group. Conclusion Both bupropion and escitalopram were effective in treating and managing IGD symptoms. Moreover, bupropion appeared to be more effective than escitalopram in improving attention and impulsivity in IGD patients. In addition, attention and impulsivity seem to be important for the management of IGD.

Introduction Atopic dermatitis (AD) is a type of chronic, recurrent inflammatory skin disorder that is emerging as a major healthcare problem in Korea. We aimed to develop clinical practice guidelines (CPGs) for AD and to provide recommendations for the diagnosis and management of AD on acupuncture and herbal medicine supported by both evidence and data related to the disease. Methods An expert group was convened to establish the most efficient system of clinical care based on the use of acupuncture and herbal medicine administered as part of Korean Medicine (KM) for the treatment of AD by drawing on a vast and diverse corpus of clinical data, with the goal of eventually establishing a foundation for evidence-based KM. This expert group devised a plan to publish clinical guidelines and collected and analysed currently available evidence for the development of the CPG. Results Six recommendations were developed for the treatment of AD on acupuncture and herbal medicine. Four of the recommendations were primarily related to herbal medicine, and two were related to acupuncture. Conclusion We developed CPG for AD using evidence-based medicine. This work is expected to lay the groundwork for a high-quality, follow-up clinical study on KM and to establish a foundation for a domestic KM group to assume the lead in the standardization of KM, thereby supporting international research.