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Facelifting techniques have been developed over time to mask the aging process. However, conventional facelifts cause scarring. Because of patient demands, various noninvasive lifting techniques have been introduced, including absorbable thread lifting. Minilifting is known for its short-scar excision and is used to improve skin laxity and lifting using absorbable threads but the definition and operation techniques are not certain. In this article, we described the definition, development, and operative techniques used in minilifts. Minilifting procedures represent an added option for patients with minimal scarring and adequate lifting effects.

Abstract Background Among the various methods used, administrative data collected for claims and billing purposes, such as diagnosis codes and present-on-admission (POA) indicators, can easily be employed to assess patient safety status. However, it is crucial that administrative data be accurate to generate valid estimates of adverse event (AE) occurrence. Thus, we aimed to evaluate the accuracy of diagnosis codes and POA indicators in patients with confirmed AEs in the hospital admission setting. Methods We analysed the diagnosis codes of 1,032 confirmed AE cases and 6,754 non-AE cases from the 2019 Patient Safety Incidents Inquiry, which was designed as a cross-sectional study, to determine their alignment with the Korean Patient Safety Incidents (PSIs) Code Classification System. The unit of analysis was the individual case rather than the patient, because two or more AEs may occur in one patient. We examined whether the primary and secondary diagnostic codes had PSIs codes matching the AE type and checked each PSI code for whether the POA indicator had an ‘N’ tag. We reviewed the presence of PSI codes in patients without identified AEs and calculated the correlation between the AE incidence rate and PSI code and POA indicator accuracy across 15 hospitals. Results Ninety (8.7%) of the AE cases had PSI codes with an ‘N’ tag on the POA indicator compared to 294 (4.4%) of the non-AE cases. Infection- (20.4%) and surgery/procedure-related AEs (13.6%) had relatively higher instances of correctly tagged PSI codes. We did not identify any PSI codes for diagnosis-related incidents. While we noted significant differences in AE incidence rates, PSI code accuracy, and POA indicator accuracy among the hospitals, the correlations between these variables were not statistically significant. Conclusion Currently, PSI codes and POA indicators in South Korea appear to have low validity. To use administrative data in medical quality improvement activities such as monitoring patient safety levels, improving the accuracy of administrative data should be a priority. Possible strategies include targeted education on PSI codes and POA indicators and introduction of new evaluation indicators regarding the accuracy of administrative data.

Abstract Background Physical restraint (PR) is used to ensure the safety of care recipients. However, this causes an ethical dilemma between the autonomy and dignity of the recipients and the provision of effective treatment by health workers. This study aimed to analyze legal and ethical situations related to the use of PR using written judgments. Methods This study uses a qualitative retrospective design. Qualitative content analysis was performed on South Korean written judgments. A total of 38 cases from 2015 to 2021 were categorized. The types of court decisions and ethical dilemma situations were examined according to the four principles of bioethics, and the courts’ judgments were compared. Results Written judgments related to PR were classified into three types according to the appropriateness of PR use, the presence or absence of duty of care, and legal negligence. Ethical dilemmas were categorized into three situations depending on whether the four principles of bioethics were followed. The courts’ decisions regarding the ethical dilemmas differed depending on the situational factors before and after the use of PR and the conflicting conditions of the ethical principles. Conclusions Health workers should consider legal and ethical requirements when determining whether to use PR to provide the care recipient with the necessary treatment.

Background Hyaluronic acid fillers can be manufactured using various processes. They have multiple properties, including their concentration, degree of modification, and rheological data. Cohesion is one such property to evaluate gel integrity; however, there is no standardized method for calculating this parameter. This study aimed to evaluate different tests for calculating hyaluronic acid cohesion and discuss the importance of hyaluronic acid cohesion as a consideration when selecting fillers.

The etiology and pathophysiology of delayed inflammatory reactions caused by hyaluronic acid fillers have not yet been elucidated. Previous studies have suggested that the etiology can be attributed to the hyaluronic acid filler itself, patient's immunological status, infection, and injection technique. Hyaluronic acid fillers are composed of high-molecular weight hyaluronic acids that are chemically cross-linked using substances such as 1,4-butanediol diglycidyl ether (BDDE). The mechanism by which BDDE cross-links the two hyaluronic acid disaccharides is still unclear and it may exist as a fully reacted cross-linker, pendant cross-linker, deactivated cross-linker, and residual cross-linker. The hyaluronic acid filler also contains impurities such as silicone oil and aluminum during the manufacturing process. Impurities can induce a foreign body reaction when the hyaluronic acid filler is injected into the body. Aseptic hyaluronic acid filler injections should be performed while considering the possibility of biofilm formation or delayed inflammatory reaction. Delayed inflammatory reactions tend to occur when patients experience flu-like illnesses; thus, the patient's immunological status plays an important role in delayed inflammatory reactions. Large-bolus hyaluronic acid filler injections can induce foreign body reactions and carry a relatively high risk of granuloma formation.

Facial massages are frequently performed to achieve a feeling of freshness, rejuvenation, skin tightening, and delayed onset of wrinkles. However, vigorous massages can induce unexpected symptoms. Here, we present a case of a woman who complained of an asymmetric facial appearance and a mass-like lesion following a long-term facial massage intervention. A facelift incision was performed. Platysma muscle rupture was observed intraoperatively, which was then repaired. To our knowledge, this is the first report of a vigorous facial massage-induced ipsilateral platysma rupture.

Doppler ultrasound can be used to detect almost all arteries of the face before injecting the hyaluronic acid (HA) filler. The relatively more dangerous sites of filler injection are the glabellar wrinkle, forehead, temple, nose, and nasolabial fold area, and it is recommended to map the vasculature of these areas by Doppler ultrasound before performing filler injection. The Doppler ultrasound detection method is included as a video. Internal carotid arterial branches, the supratrochlear, supraorbital, and dorsal nasal arteries, and external carotid arterial branches, the superficial temporal and facial arteries, are very important arteries when injecting HA filler; thus, Doppler ultrasound detection is recommended.

Objective: The objective of this study is to compare the microbiome of healthy peri-implant sulcus (C) and peri-implantitis sulcus (U) from the same patient and analyze the difference in the microbiome composition. Materials and methods: DNA samples of subgingival biofilms from 10 C (control group) and 10 U (uncontrolled group) sites were sent to Microbiome Center in Korea Research Institute of Biomedical Science and analyzed using 16s rRNA gene amplification and sequencing (MiSeq, Illumina) and human oral microbiome database (HOMD). Results: At the phylum level, Firmicutes and Proteobacteria were more abundant in group C, while Firmicutes and Bacteroidetes were dominant in group U. At the genus level, the core peri-implant microbiome was Streptococcus in group C. On the other hand, the core peri-implant microbiome was Porphyromonas, especially P. gingivalis in group U. Conclusion: In this study, the microbiome composition of peri-implantitis sulcus was different from that of healthy peri-implant sulcus from the same patient. The peri-implantitis microbiome was pathogen-enriched and was similar to the microbiome associated with periodontitis.

Quantitative and qualitative research explore various social phenomena using different methods. However, there has been a tendency to treat quantitative studies using complicated statistical techniques as more scientific and superior, whereas relatively few qualitative studies have been conducted in the medical and healthcare fields. This review aimed to provide a proper understanding of qualitative research. This review examined the characteristics of quantitative and qualitative research to help researchers select the appropriate qualitative research methodology. Qualitative research is applicable in following cases: (1) when an exploratory approach is required on a topic that is not well known, (2) when something cannot be explained fully with quantitative research, (3) when it is necessary to newly present a specific view on a research topic that is difficult to explain with existing views, (4) when it is inappropriate to present the rationale or theoretical proposition for designing hypotheses, as in quantitative research, and (5) when conducting research that requires detailed descriptive writing with literary expressions. Qualitative research is conducted in the following order: (1) selection of a research topic and question, (2) selection of a theoretical framework and methods, (3) literature analysis, (4) selection of the research participants and data collection methods, (5) data analysis and description of findings, and (6) research validation. This review can contribute to the more active use of qualitative research in healthcare, and the findings are expected to instill a proper understanding of qualitative research in researchers who review qualitative research reports and papers.

Abstract Polypharmacy and its rising global prevalence is a growing public health burden. Using a large representative nationwide Korean cohort (N = 761,145), we conducted a retrospective cross-sectional study aiming to identify subpopulations of patients with polypharmacy and characterize their unique patterns through cluster analysis. Patients aged ≥ 30 years who were prescribed at least one medication between 2014 and 2018 were included in our study. Six clusters were identified: cluster 1 mostly included patients who were hospitalized for a long time (4.3 ± 5.3 days); cluster 2 consisted of patients with disabilities (100.0%) and had the highest mean number of prescription drugs (7.7 ± 2.8 medications); cluster 3 was a group of low-income patients (99.9%); cluster 4 was a group of high-income patients (80.2%) who frequently (46.4 ± 25.9 days) visited hospitals/clinics (7.3 ± 2.7 places); cluster 5 was mostly elderly (74.9 ± 9.8 years) females (80.3%); and cluster 6 comprised mostly middle-aged (56.4 ± 1.5 years) males (88.6%) (all P

Background: Elucidating nurses’ adaptation to changes in the early stage of an infectious disease epidemic is necessary to promote nurses' coping with and adapting to situations in which new infectious diseases are predicted periodically. Aim: To explore nurses’ adaptation to changes in COVID-19 wards in South Korea. Methods: In-depth interviews were conducted with 20 nurses through purposive sampling from May to August 2020. The collected data were transcribed verbatim, and analysis was performed using conventional content analysis. Findings: Three categories emerged from the interviews: (a) Disruption caused by an unforeseen pandemic outbreak, (b) perseverance through the turmoil of changes as a nurse, and (c) transition from feelings of fearfulness to those of accomplishment. While the nurses initially struggled to care for patients with COVID-19, they made conscious efforts to provide emotional nursing and maintain their professionalism. Discussion: Nurses caring for patients with COVID-19 have faced a number of challenges but have adapted to new scenarios by endeavoring to fulfil their professional roles. Conclusion: To overcome a national disaster situation such as COVID-19, the government and healthcare organizations should prepare strategies to support the efforts of nurses to strengthen their own professionalism.

The COVID-19 pandemic has sparked a rapid worldwide increase in the utilization of delivery services. This study delves into the experiences of delivery workers as one of the activley developed industries during the COVID-19 pandemic in South Korea and sheds light on the effects of the pandemic on their working conditions. Through in-depth interviews with 10 Korean delivery workers, data analysis employed the hermeneutic phenomenology research method developed by Van Manen. The findings indicate a substantial rise in income levels and a positive societal perception of delivery labor post-COVID-19. The pandemic also attracted many new workers to the industry due to low entry barriers and work flexibility. However, challenges persisted as delivery workers grappled with an uncertain legal status and sometimes jeopardized their safety to boost earnings in shorter time frames. The pivotal role played by delivery workers in enhancing communal quality of life and connectivity during the pandemic cannot be overlooked. As we step into a post-COVID-19 era, comprehensive efforts are needed to enhance the working environment for delivery workers globally. Notably, clarifying the relationship between delivery workers and companies within the novel digital labor landscape is essential, alongside establishing institutional frameworks to safeguard workers' basic rights, including health and safety provisions.

Abstract Background Botulinum toxin A can be used to eliminate dynamic wrinkles by relaxing the muscles involved in facial expressions. Therefore, it is essential to know the location, origin, insertion, function, and changes of the facial expression muscles according to their contraction. Methods After drawing the muscles on the face of a model, pictures were taken at rest. The model was then asked to make facial expressions that cause facial wrinkles. All images were taken with the Vectra H1 camera system (Canfield Scientific, Inc., Fairfield, New Jersey). Each expression image was aligned to its respective static image to compute the differences in skin position, so as to calculate the skin displacement vectors. The values for local changes in skin displacement were calculated by applying the automated algorithms of the Vectra Software Mirror Suite and visualized using the color and size of the arrow. Results Face painting and 3D skin vector displacement analyses enabled visualization of all the facial muscles involved in facial expressions working dynamically, allowing us to visualize the effect of each muscle in the creation of hyperkinetic wrinkles. Face painting and 3D skin vector displacement analyses can be combined to determine the location of the wrinkles, extent of the muscle, part of the muscle that contracts, presence of asymmetry, direction in which the muscle contracts, and correlation between the antagonists and synergistic muscles. Conclusion The botulinum toxin A injection educational model using body painting and 3D skin vector displacement analyses can provide a deeper understanding of actual moving muscle anatomy. Level of Evidence 4.

Purpose The purpose of this study was to evaluate the impact of synchronous online education on the patient safety competency (knowledge, attitudes, and skills) of nursing students in Korea and to explore what they thought about this educational method. Methods A single-group pre-and post-test design and summative content analysis were implemented. On November 14th, 2020, 110 nursing students completed synchronous online patient safety education. Patient safety competency was measured before and after the intervention using the revised Patient Safety Competency Self-Evaluation tool. The descriptive statistics, paired t-test, and Wilcoxon signed-rank test were used to analyze the data. Students also expressed their opinions about this education based on open-ended questions. Results All the patient safety competency scores significantly increased after intervention. A summative content analysis of the open-ended questions yielded 5 categories: educational materials, education level, education time, interaction, and educational media. Conclusion This study found that synchronous online patient safety education improves nursing students’ knowledge on, attitudes towards, and skills in patient safety. Nursing students also expressed a variety of positive aspects of the online education method. To improve the efficacy of synchronous online patient safety education, there is a need for further empirical studies on the appropriate class duration and difficulty of the content. It is essential to find a way to combine online education with various learning activities.

Abstract Competent social functioning of group-living species relies on the ability of individuals to detect and utilize conspecific social cues to guide behavior. Previous studies have identified numerous brain regions involved in processing these external cues, collectively referred to as the Social Decision-Making Network. However, how the brain encodes social information with respect to an individual’s social status has not been thoroughly examined. In mice, cues about an individual’s identity, including social status, are conveyed through urinary proteins. In this study, we assessed the neural cFos immunoreactivity in dominant and subordinate male mice exposed to familiar and unfamiliar dominant and subordinate male urine. The posteroventral medial amygdala was the only brain region that responded exclusively to dominant compared to subordinate male urine. In all other brain regions, including the VMH, PMv, and vlPAG, activity is modulated by a combination of odor familiarity and the social status of both the urine donor and the subject receiving the cue. We show that dominant subjects exhibit robust differential activity across different types of cues compared to subordinate subjects, suggesting that individuals perceive social cues differently depending on social experience. These data inform further investigation of neurobiological mechanisms underlying social-status related brain differences and behavior.

Although hyaluronic acid (HA) filler injections are associated with various non-vascular inflammatory complications, the underlying mode of action remains unclear. The hyaluronic acid filler may not be sufficiently pure, leading to an immune response. The present study attempted to identify any impurities in hyaluronic acid fillers available on the market. Particles were counted after degrading hyaluronic acid filler with hyaluronidase. Particulate matter was subsequently observed using scanning electron microscopy, and the particle components were evaluated using energy-dispersive X-ray spectroscopy. Different quantities of impurity particles (>10 and 25 μm) were detected microscopically. Silicon and aluminum isotopes were also detected. Hyaluronic acid fillers were contaminated with these particles. The degree of contamination varied substantially among the tested filler products. These contaminant particles may evoke reactions in the patient’s body. Clinicians should be aware of this source of possible contamination and its effects.

Background/Aims Possible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis. Methods A total of 13 cases (20 judgments) found in the Supreme Court of Korea’s Written Judgment Management System from 1998 to 2017 were analyzed. Results Coronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won. Conclusions Physicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

PurposeObstructive sleep apnea (OSA) is an established independent risk factor for peripheral neuropathy. Macro and microvascular changes have been documented in OSA, including high levels of potent vasoconstrictors. In diabetes, vasoconstriction has been identified as an underlying risk factor for corneal neuropathy. This study sought to establish a potential relationship between OSA and corneal nerve morphology and sensitivity, and to determine whether changes in corneal nerves may be reflective of OSA severity.DesignSingle center cross-sectional study.MethodsSixty-seven patients were stratified into two groups: those with OSA and healthy controls. Groups were matched for age, sex, race, smoking, and dry eye status. Outcome measures included serologies, a dilated fundus exam, dry eye testing, anthropometric parameters, corneal sensitivity, subbasal nerve plexus morphology, retinal nerve fiber layer (RNFL) thickness, and the use of questionnaires to assess symptoms of dry eye disease, risk of OSA, and continuous positive airway pressure (CPAP) compliance.ResultsNo significant differences were observed in corneal nerve morphology, sensitivity, or the number of dendritic cells. In the OSA test group, RNFL thinning was noted in the superior and inferior regions of the optic disc and peripapillary region. A greater proportion of participants in the OSA group required a subsequent evaluation for glaucoma than in the control. In those with OSA, an increase in the apnea hypopnea index was associated with an increase in optic nerve cupping.ConclusionsOSA does not exert a robust effect on corneal nerves. OSA is however, associated with thinning of the RNFL. Participants with glaucomatous optic nerve changes and risk factors for OSA should be examined as uncontrolled OSA may exacerbate glaucoma progression.

In an era where migration across borders is increasingly the norm, how are our understandings of language and the ways we talk about language being reimagined along the way? This article examines this question by attending to the shifting metadiscourses of "Chinglish," a colloquialism referring to Chinese-English hybridizations. Chinglish, originally used to describe an incompetent interlanguage, has come to be invoked as a means of establishing "China English" as a legitimate world English variety, or more recently even as an innovative form of translingual practice. This article presents Chinglish as a form of "border languaging," which enables us to take stock of the shifting meanings of Chinglish in relation to the linguistic "border" between English and Chinese upon which such metadiscursive framings hinge, and how the shifting orientations to such linguistic borders invite new ways of conceptualizing Chinglish and historically marginalized language practices more generally.

We conducted a meta-analysis to investigate reading-writing relations. Beyond the overall relation, we systematically investigated moderation of the relation as a function of linguistic grain size (word reading and spelling versus reading comprehension and written composition), measurement of reading comprehension (e.g., multiple choice, open-ended, cloze), and written composition (e.g., writing quality, writing productivity, writing fluency, writing syntax), and developmental phase of reading and writing (grade levels as a proxy). A total of 395 studies (k = 2,265, N = 120,669) met inclusion criteria. Overall, reading and writing were strongly related (r = 0.72). However, the relation differed depending on the subskills of reading and writing such that word reading and spelling were strongly related (r = 0.82) whereas reading comprehension and written composition were moderately related (r = 0.44). In addition, the word reading-spelling relation was stronger for primary-grade students (r = 0.82) than for university students/adults (r = 0.69). The relation of reading comprehension with written composition differed depending on measurement of reading comprehension and written composition--reading comprehension measured by multiple choice and open-ended tasks had a stronger relation with writing quality than reading comprehension measured by oral retell tasks; and reading comprehension had moderate relations with writing quality, writing vocabulary, writing syntax, and writing conventions but had weak relations with writing productivity and writing fluency. Relations tended to be stronger when reliability was higher, and the relation between word reading and spelling was stronger for alphabetic languages (r = 0.83) than for Chinese (r = 0.71). These results add important nuances about the nature of relations between reading and writing.

In the assessment of second language oral communication, the video-call speaking test has received increasing attention as a test method with higher practicality than its in-person counterpart, but still with broad coverage of the test construct. Previous studies into video-call assessment have focussed on the individual (as opposed to paired or group) interactional format. The current study extends this line of research by focussing on paired speaking interactions, with a specific focus on the construct of interactional competence. A concurrent triangulation design was adopted with the use of both quantitative and qualitative data through recordings and scores of test performances, questionnaires, and focus groups. Findings indicate that video-call paired interactions in the assessment context of interest in this study are largely comparable to in-person interactions in terms of scores, with statistically small-effect size differences identified. Some differences in terms of turn-taking management, examiner, and test-taker perceptions were also identified. We argue for a more in-depth awareness of the characteristics of video-call speaking in its own right, which can inform both assessment and learning contexts.

Abstract Background Healthcare professionals who experience trauma due to patient safety incidents can be considered second victims, and they also suffer from various difficulties. In order to support second victims, it is necessary to determine the circumstances of the incidents in question, along with the symptoms that the victims are experiencing and the support they require. A qualitative study on healthcare professionals of various occupations, such as physicians and nurses working in Korea, was conducted, and the experiences and response methods and processes of second victims were examined. Methods In-depth interviews were conducted with 16 healthcare professionals (six physicians, eight nurses, and two pharmacists) who had experienced a patient safety incident. All interviews were recorded and transcribed, and the data analysis was conducted in accordance with Strauss and Corbin’s grounded theory. Both open coding and axial coding were performed. Consolidated criteria for reporting qualitative research (COREQ) were applied in this study. Results The results of the open coding demonstrated that the experiences of second victims can be categorized into “the reactions of the first victim and surrounding people after the incident,” “Influence of factors aside from the incident,” “the initial complex responses of the participants to the incident,” “open discussion of the incident,” “the culture in medical institutions regarding early-stage incident response,” “the coping responses of the participants after incidents,” and “living with the incident.” Then, the seven categories in the open coding stage were rearranged according to the paradigm model, and the reaction process of the second victims was analyzed through process analysis, being divided into the “entanglement stage,” “agitating stage,” “struggling stage,” “managing stage,” and “indurating stage.” Conclusions This research is significant because it provides a comprehensive understanding of second victims’ experiences in the eastern region of Korea, by obtaining data using a qualitative research method. The findings of the study also highlight the five stages of the second victim response process, and can be used to design a specialized second victim support program in Korea.

We propose the conditions for maximum overall efficiency at the constraint of satisfying asymmetric load power requirements for each receiver, for multiple-receivers wireless power transfer. Previously, the limitation of multiple-receiver analysis was that only the efficiency was maximized, whereas the requirements of load power were neglected. In many cases, conventional efficiency maximization assigns insufficient power to receivers far from the transmitter, while supplying excessive power to receivers near the transmitter. To resolve this limitation, we maximize the efficiency at the constraints of specified load power for each receiver. The proposed closed-form equation provides an optimum TX coil current amplitude, and the optimum load resistances of each receiver, to achieve the maximum efficiency at the load power regulation.

Background:. Threadlifts are classified as absorbable or nonabsorbable, natural or synthetic, and multifilament or monofilament ones, each of which has its own merits and demerits. We placed a novel absorbable polydioxanone monofilament threadlift (Mint Lift Fine; HansBiomed Co. Ltd., Seoul, Korea) in the subcutaneous fat compartment for facial rejuvenation in patients with nasolabial folds, nasojugal groove, marionette lines, or sagging jowl. Here, we describe its short-term treatment outcomes in a retrospective consecutive series of 21 patients. Methods:. A total of 21 patients (n = 21) were evaluated; their treatment outcomes were described based on a comparison between preoperative and postoperative findings and Global Aesthetic Improvement Scale (GAIS) scores were assessed at 6 months. This is accompanied by analysis of the incidence of postoperative complications. Results:. The patients had a mean GAIS score of 3.62 ± 0.84 points, which corresponds to “Much improved” or “Very much improved.” Moreover, there were no significant differences in the GAIS scores between the target sites (midface and lower face: 3.78 ± 1.13; lower face: 3.43 ± 0.50; and midface: 3.60 ± 0.49; P > 0.05). Furthermore, there were a total of 4 cases (19.0%) of postoperative complications, all of which were spontaneously resolved within a maximum period of 4 months. Conclusions:. We describe short-term treatment outcomes of facial rejuvenation using the Mint Lift Fine in patients with nasolabial folds, nasojugal groove, marionette lines, or sagging jowl. But further large-scale, prospective, multicenter studies with long periods of follow-up are, therefore, warranted to establish our results.

The present study investigated physicians' perceptions regarding the need for, effects of, and barriers to disclosure of patient safety incidents (DPSI). An anonymous online questionnaire survey was conducted to investigate physicians' perception regarding DPSI, in particular of when DPSI was needed in various situations and of methods for facilitating DPSI. Physicians' perceptions were then compared to the general public's perceptions regarding DPSI identified in a previous study. A total of 910 physicians participated. Most participants (94.9%) agreed that any serious medical error should be disclosed to patients and their caregivers, whereas only 39.8% agreed that even near-miss errors, which did not cause harm to patients, should be disclosed. Among the six known effects of DPSI presented, participating physicians showed the highest level of agreement (89.6%) that "DPSI will lead physicians to pay more attention to patient safety in the future." Among six barriers to DPSI, participants showed the most agreement (75.9%) that "It is unreasonable to demand DPSI in only the medical field, and disclosure is not actively conducted in other fields." With respect to methods for facilitating DPSI, participants agreed that "A guideline for DPSI is needed" (91.2%) and "Manpower to support DPSI in hospitals is required" (89.1%). Meanwhile, 79.3% agreed that "If an apology law is enacted, physicians will perform more DPSI" and 72.4% that "I support the introduction of an apology law." Korean physicians generally have a positive perception of DPSI, but less than the general public.

Mechanical/physical stimulations modulate tissue metabolism, and this process involves multiple cellular mechanisms, including the secretion of growth factors and the activation of mechano-physically sensitive kinases. Cells and tissue can be modulated through specific vibration-induced changes in cell activity, which depend on the vibration frequency and occur via differential gene expression. However, there are few reports about the effects of medium-magnitude (1.12 g) sonic vibration on the osteogenic differentiation of human dental pulp stem cells (HDPSCs). In this study, we investigated whether medium-magnitude (1.12 g) sonic vibration with a frequency of 30, 45, or 100 Hz could affect the osteogenic differentiation of HDPSCs. Their cell morphology changed to a cuboidal shape at 45 Hz and 100 Hz, but the cells in the other groups were elongated. FACS analysis showed decreased CD 73, CD 90, and CD 105 expression at 45 Hz and 100 Hz. Additionally, the proportions of cells in the G0/G1 phase in the control, 30 Hz, 45 Hz, and 100 Hz groups after vibration were 60.7%, 65.9%, 68.3%, and 66.7%, respectively. The mRNA levels of osteogenic-specific markers, including osteonectin, osteocalcin, BMP-2, ALP, and Runx-2, increased at 45 and 100 Hz, and the ALP and calcium content was elevated in the vibration groups compared with those in the control. Additionally, the western blotting results showed that p-ERK, BSP, osteoprotegerin, and osteonectin proteins were upregulated at 45 Hz compared with the other groups. The vibration groups showed higher ALP and calcium content than the control. Vibration, especially at 100 Hz, increased the number of calcified nodes relative to the control group, as evidenced by von Kossa staining. Immunohistochemical staining demonstrated that type I and III collagen, osteonectin, and osteopontin were upregulated at 45 Hz and 100 Hz. These results suggest that medium magnitude vibration at 45 Hz induces the G0/G1 arrest of HDPSCs through the p-ERK/Runx-2 pathway and can serve as a potent stimulator of differentiation and extracellular matrix production.

Purpose: The objective of this study was to provide a descriptive understanding of the characteristics of malpractice litigation re-lated to urology by examining court cases.Materials and Methods: A total of 6,074 court cases related to medical malpractice litigation filed between 2005 and 2010 were received from the Lower Courts, the Appellate Courts, and the Supreme Court of Korea. Of the received cases, 34 urology-related civil proceedings were analyzed. The following information was compiled and investigated from the cases: background, age and sex of patient, categorization of the defendant, opinion of the court, amount claimed and awarded in damages, type of medical treatment involved, and negative effects resulting from the medical accident.Results: The average amount in damages paid out to plaintiffs in this research was 27,186,504±32,371,008 Korean won (KRW) (range, 1,000,000–100,000,000 KRW). A total of 9 of the 34 analyzed cases (26.5%) ruled in favor of the plaintiff, with all 9 cases involving a surgery. An analysis of the surgery sites further revealed that the penis was the most frequently litigated over site of surgery, making up 14 of the 35 sites (40.0%).Conclusions: Information regarding urology malpractice lawsuits should be made available to help prevent further disputes and litigation. Continuous efforts must be expended in the prevention of accidents and disputes, alongside research into urology-re-lated cases beyond 2010. Extensive cause analysis and recurrence prevention methods must also be researched to enhance overall patient safety.

Socially competent animals must learn to modify their behavior in response to their social partner in a contextually appropriate manner. Dominant-subordinate relationships are a particularly salient social context for mice. Here we observe and analyze the microstructure of social and non-social behaviors as 21 pairs of outbred CD-1 male mice (Mus Musculus) establish dominant-subordinate relationships during daily 20-minute interactions for five consecutive days in a neutral environment. Firstly, using a Kleinberg burst detection algorithm, we demonstrate aggressive and subordinate interactions occur in bursting patterns followed by quiescent periods rather than being uniformly distributed across social interactions. Secondly, we identify three phases of dominant-subordinate relationship development (pre-, middle-, and post-resolution) by utilizing two statistical methods to identify stability in aggressive and subordinate behavior across these bursts. Thirdly, using First Order Markov Chains we find that dominant and subordinate mice show distinct behavioral transitions, especially between tail rattling and other aggressive/subordinate behaviors. Further, dominant animals engaged in more digging and allogrooming behavior and were more likely to transition from sniffing their partner's body to head, whereas subordinates were more likely to transition from head sniffing to side-by-side contact. Lastly, we utilized a novel method (Forward Spike Time Tiling Coefficient) to assess how individuals respond to the behaviors of their partner. We found that subordinates decrease their tail rattling and aggressive behavior in response to aggressive but not subordinate behavior exhibited by dominants and that tail rattling in particular may function to deescalate aggressive behavior in pairs. Our findings demonstrate that CD-1 male mice rapidly establish dominance relationships and modify their social and non-social behaviors according to their current social status. The methods that we detail also provide useful tools for other researchers wishing to evaluate the temporal dynamics of rodent social behavior.

Gastrointestinal mucormycosis is a rare infection in solid organ transplant recipients. Our patient, a 79-year-old male, presented with severe dysphagia and odynophagia about 2 weeks after receiving a renal transplant. An upper gastrointestinal (UGI) endoscopy revealed esophagitis and gastric ulceration, the cultures from which grew Rhizopus species. A usual treatment strategy should include Amphotericin B as monotherapy or in combination with Posaconazole or Isavuconazole for such infections. Our patient was treated with Isavuconazole monotherapy, in an effort to minimize renal toxicity from Amphotericin B to the new allograft. Unique to our case was a successful clinical response and resolution of UGI lesions with Isavuconazole monotherapy. Due to the vagueness of presenting symptoms, such infections can be easily missed in an immunocompromised patient which can have tragic outcomes. Prompt diagnosis and modulation of immunosuppression are essential to decrease mortality and morbidity. Isavuconazole is a novel agent and can be used as a monotherapy for such infections, especially in renal transplant recipients.

Living in social hierarchies requires individuals to adapt their behavior and physiology. We have previously shown that male mice living in groups of 12 form linear and stable hierarchies with alpha males producing the highest daily level of major urinary proteins and urine. These findings suggest that maintaining alpha status in a social group requires higher food and water intake to generate energetic resources and produce more urine. To investigate whether social status affects eating and drinking behaviors, we measured the frequency of these behaviors in each individual mouse living in a social hierarchy with non-stop video recording for 24 h following the initiation of group housing and after social ranks were stabilized. We show alpha males eat and drink most frequently among all individuals in the hierarchy and had reduced quiescence of foraging both at the start of social housing and after hierarchies were established. Subdominants displayed a similar pattern of behavior following hierarchy formation relative to subordinates. The association strength of foraging behavior was negatively associated with that of agonistic behavior corrected for gregariousness (HWIG), suggesting animals modify foraging behavior to avoid others they engaged with aggressively. Overall, this study provides evidence that animals with different social status adapt their eating and drinking behaviors according to their physiological needs and current social environment.

Background Glomus tumors were first described by Wood in 1812 as painful subcutaneous tubercles. It is an uncommon benign neoplasm involving the glomus body, an apparatus that involves in thermoregulation of cutaneous microvasculature. Glomus tumor constitutes 1%-5% of all hand tumors. It usually occurs at the subungual region and more commonly in aged women. Its classical clinical triad consists of pain, tenderness and temperature intolerance, especially cold sensitivity. This study reviews 15 cases of glomus tumor which were analyzed according to its anatomic location, surgical approach and histologic findings. Methods Fifteen patients with subungual glomus tumors of the hand operated on between January 2006 and March 2013, were retrospectively reviewed. Patients were evaluated preoperatively with standard physical examination including ice cube test and Love's test. Diagnostic imaging consisted of ultrasonography, computed tomography, and magnetic resonance imaging. All procedures were performed with tourniquet control under local anesthesia. Eleven patients underwent excision using the transungual approach, 3 patients using the volar approach and 1 patient using the lateral subperiosteal approach. Results Total of 15 cases were reviewed. 11 tumors were located in the nail bed, 3 in the volar pulp and 1 in the radial aspect of the finger tip. After complete excision, patients remained asymptomatic in the immediate postoperative period. In the long term follow up, patients exhibited excellent cosmetic results with no recurrence. Conclusions Accurate diagnosis should be made by physical, radiologic and pathologic examinations. Preoperative localization and complete extirpation is essential in preventing recurrence and subsequent nail deformity.

Outer membrane vesicles (OMVs) are spherical bilayered phospholipids of 20-200 nm in size produced from all Gram-negative bacteria and Gram-positive bacteria investigated to date. Previous biochemical and proteomic studies have revealed that the Gram-negative bacteria-derived OMVs are composed of various components like outer membrane proteins, lipopolysaccharides, outer membrane lipids, periplasmic proteins, DNA, and RNA. Here, in this protocol, we describe the method to isolate the OMVs from the culture supernatant of Escherichia coli (E. coli).

Outer membrane vesicles (OMVs) are spherical bilayered phospholipids of 20-200 nm in size produced from all Gram-negative bacteria and Gram-positive bacteria investigated to date. OMVs, which resemble the outer membrane and periplasm in composition, are proinflammatory and immunogenic facsimiles, and therefore could activate both innate and adaptive immunity. Here, we describe the OMVs immunization protocol and bacteria challenge protocol to induce bacterial sepsis in mice.