Obesity mechanism after hypothalamic damage: Cohort analysis of neuroimaging, psychological, cognitive, and clinical phenotyping data.

Objective: The hypothalamus regulates energy homeostasis, and its damage results in severe obesity. We aimed to investigate the multifaceted characteristics of hypothalamic obesity. Methods: We performed multidimensional analyses of brain structure/function and psychological and behavioral phenotypes in 29 patients with hypothalamic damage (HD) (craniopharyngioma) and 31 controls (non-functional pituitary adenoma). Patients underwent structural and functional magnetic resonance imaging and completed self-reports and cognitive tasks. Results: Patients with HD showed significantly higher postoperative weight gain than controls. The HD group also showed significant hypothalamic damage and lower neural activation in the left caudate nucleus in response to food images. The HD group had significantly higher food inattention, lower satiety, and higher restrained eating behavior. Within the HD group, higher restrained eating behavior was significantly associated with lower activation in the bilateral fusiform gyrus. Conclusion: These results suggest that hypothalamic damage contributes to weight gain by altering the brain response, attention, satiety, and eating behaviors. The present study proposes novel neuro-psycho-behavioral mechanisms targeted for patients with hypothalamic obesity.

Development of clinical practice guidelines for Korean medicine: Towards evidence-based complementary and alternative medicine.

Background: Since evidence-based medicine has been pursued in complementary and alternative medicine, the clinical practice guideline (CPG) has become a key factor in providing standardized and validated practices in Korean Medicine (KM). We aimed to review the current status and characteristics of the development, dissemination, and implementation of KM-CPGs. Methods: We searched KM-CPGs and relevant publication via web-based databases. We organized the searching results focused on the year of publications and the development programs to show which and how KM-CPGs have been development. We also reviewed the manuals for KM-CPG development to introduce concise characteristics of the KM-CPGs published in Korea. Results: The KM-CPGs have been developed according to manuals and standard templates for developing evidence-based KM-CPGs. First, CPG developers reviews the previously published CPGs for a clinical condition of interest and plans the CPG development. After finalizing the key clinical questions, the evidence is searched, selected, appraised, and analyzed following the internationally standardized methods. The quality of the KM-CPGs is controlled by a tri-step appraisal process. Second, the CPGs were submitted for the appraisal of the KM-CPG Review and Evaluation Committee. The committee evaluates the CPGs according to the AGREE II tool. Finally, the Steering Committee of the KoMIT project reviews the entire process of developing the CPGs and confirms it for public disclosure and dissemination. Conclusion: Evidence-based KM from research to practice can be achieved with the attention and effort of multidisciplinary entities such as clinicians, practitioners, researchers, and policymakers for the CPGs.

Bee Venom Acupuncture for Neck Pain: A Review of the Korean Literature.

Bee venom is a natural toxin that is effective in treating various types of pain. The purpose of this paper was to review all the features of clinical studies conducted on bee venom acupuncture (BVA) for the treatment of neck pain in Korean publications. Six Korean databases and 16 Korean journals were searched in August 2022 for clinical studies on BVA for neck pain. We identified 24 trials that met our inclusion criteria, of which 316 patients with neck pain were treated with BVA. The most common diagnosis in the patients with neck pain was herniated intervertebral discs (HIVDs) of the cervical spine (C-spine) (29.2%), and the concentration and dosage per session were 0.05-0.5 mg/mL and 0.1-1.5 mL, respectively. The visual analog scale was most often measured for neck pain severity (62.5%), and all clinical research reported improvements in 16 outcome measures. This study shows that BVA could be recommended for the treatment of neck pain, especially HIVD of the C-spine; however, the adverse effects of BVA must be examined in future studies.

Clinical Studies of Bee Venom Acupuncture for Lower Back Pain in the Korean Literature.

This study aimed to identify all of the characteristics of bee venom acupuncture (BVA) for the treatment of lower back pain (LBP) that are described in the Korean literature, and to provide English-speaking researchers with bibliometrics. Six Korean electronic databases and sixteen Korean journals on BVA treatment for back pain were searched up to February 2022. This report included and analyzed 64 clinical studies on BVA interventions for back pain and 1297 patients with LBP. The most common disease in patients with back pain was lumbar herniated intervertebral discs (HIVD) of the lumbar spine (L-spine). All studies used bee venom (BV) diluted with distilled water. The concentration of BVA for HIVD of L-spine patients with LBP ranged from 0.01 to 5.0 mg/mL; the dosage per treatment was 0.02-2.0 mL, and for a total session was 0.3-40.0 mL. The most used outcome measure was the visual analogue scale for back pain (n = 45, 70.3%), and most of the papers reported that each outcome measure had a positive effect. Korean clinical studies were typically omitted from the review research, resulting in potential language bias. This study provides clinical cases in Korea for future development and standardization of BVA treatment for back pain.

The effect of cancer on traditional, complementary and alternative medicine utilization in Korea: a fixed effect analysis using Korea Health Panel data.

BACKGROUND: Cancer-related incidence and mortality rates are rapidly increasing worldwide. However, no studies have examined the effect of cancer as a single factor on the use of traditional, complementary, and alternative medicine (T&CAM). We aimed to determine the effect of cancer occurrence on T&CAM utilization using Korea Health Panel (KHP) data. METHODS: We analyzed longitudinal data (49,380 observations) derived from 12,975 Korean adult participants with complete KHP data from 2011 to 2014 and 2016, and divided them into two groups based on cancer diagnosis. A panel multinomial logit model was used to assess whether the participants used T&CAM or conventional medicine or both in outpatient settings. Additionally, a negative binomial regression model was used to examine the effect of cancer on the number of outpatient visits for T&CAM. RESULTS: In total, 25.54% of the study participants in the cancer group used T&CAM, which was higher than that in the non-cancer group (18.37%, p < 0.0001). A panel multinomial logistic regression analysis using KHP data showed that cancer occurrence was significantly more likely to be associated with 'Using both Korean medicine and conventional medicine' (Coef. = 0.80, p = 0.017) and 'Not using Korean medicine but using conventional medicine' (Coef. = 0.85, p = 0.008) than 'Not using Korean medicine and conventional medicine.' A panel negative binomial regression showed a significant effect of cancer on increasing the number of T&CAM outpatient visits (Coef. = 0.11, p = 0.040). CONCLUSIONS: Our findings showed that cancer occurrence within an individual led to the simultaneous use of conventional medicine and T&CAM. In addition, the occurrence of cancer significantly increased the number of T&CAM outpatient visits among participants already using T&CAM. It was also found that T&CAM has been utilized more often by the most vulnerable people, such as medical beneficiaries and those with a low level of education.

Traditional Korean Medicine Home Care for the Older Adults during the COVID-19 Pandemic in South Korea.

OBJECTIVES: The aim of this study was to examine the status of community care services regarding traditional Korean medicine (TKM) for older adults and raise awareness on current opinions and services of TKM institutions. METHODS: The National Development Institute of Korean Medicine conducted a survey of 16 local governments by sending official letters through an electronic document system from October 2020 to November 2020. The survey items included basic demographic information and information about TKM service. RESULTS: Eleven (68.8%) of the 16 local governments provided TKM home care services. A total of 136 TKM clinics provided home care services for 598 older adults with musculoskeletal disorders. The number of TKM services provided in five or more local governments were cupping 11 (100.0%), acupuncture 11 (100.0%), education and consulting 10 (90.9%), and moxibustion 9 (81.8%). Moreover, pain (recorded on visual analogue scale) and quality of life significantly improved following TKM services (p < 0.001). CONCLUSIONS: Covered under medical policy, TKM homecare services could function as a viable alternative for continued medical care disrupted during the coronavirus disease 19 pandemic. In addition, standardisation and legalisation of these services could ensure and improve their efficiency.

Electroacupuncture for Temporomandibular Disorders: A Systematic Review of Randomized Controlled Trials.

Although electroacupuncture (EA) is an effective treatment for pain relief, there has been no systematic review of EA treatment for temporomandibular disorder TMD. This systematic review aimed to evaluate the efficacy and safety of EA in TMD management. We searched 14 databases until April 2021 for randomized controlled trials (RCTs) evaluating the effects of EA on TMDs. Eleven RCTs with 667 patients that used three acupuncture points (ST6, ST7, and LI4) were included. Two RCTs reported significant effects of EA plus microwave treatment compared with EA treatment alone on the total effectiveness rate (TER) for TMD. Further, two studies reported that compared with ultrashort wave alone, EA plus ultrashort wave had a significant effect on the TER for TMD and visual analog scale. All RCTs did not report adverse events. Our findings demonstrated the positive potential of EA in TMD management. However, there was weak evidence regarding EA use for TMD management given the poor quality and small sample sizes of the included studies. In the future, well-designed RCTs are required. It is necessary to investigate clinical trials and systematic reviews to compare the effectiveness and safety of EA and acupuncture for TMD.

Quality Control of Pharmacopuncture: A Comparative Study of Good Manufacturing Practice and External Herbal Dispensary Standards.

OBJECTIVES: We aimed to compare the external herbal dispensary (EHD) evaluation criteria for pharmacopuncture and the Korea Good Manufacturing Practice (KGMP) sterile medicine standards to contribute to the establishment of quality control criteria for pharmacopuncture. METHODS: We obtained the KGMP standards from the Ministry of Food and Drug Safety and the pharmacopuncture certification criteria from the Ministry of Health and Welfare of South Korea. The EHD evaluation items were classified into three categories facilities, quality control, and validation. The evaluation items were compared with the KGMP sterile medicine criteria to determine their conformance with each other, followed by a discussion among the committee of six experts and their consensus to suggest the items to complement the EHD evaluation criteria. RESULTS: Among the KGMP sterile medicine criteria, 44 were related to the management of the facilities, and 32 pharmacopuncture evaluation items corresponded to these KGMP items (66.7%). Fifty-eight KGMP criteria were related to quality management, and 42 pharmacopuncture evaluation items corresponded to these KGMP items (72.4%). Twenty-five KGMP sterile medicine criteria were related to validation, and 11 pharmacopuncture evaluation items corresponded to these KGMP items (44.0%). Sixteen items under the pharmacopuncture EHD criteria corresponded to the KGMP sterile medicine criteria based on the consent of the experts. Among these, 4 were related to facility management, 6 were related to quality control, and 6 were related to validation. CONCLUSION: For the safety and quality control of pharmacopuncture, there is a need to select the criteria for the mandatory items among the proposed pharmacopuncture-EHD criteria laws and systems to ensure that the pharmacopuncture materials are produced under the pharmacopuncture-EHD in compliance with the relevant requirements. More studies are needed to secure the safety level of pharmacopuncture materials corresponding to that of conventional medicine.

How Suppressed Anger Can Become an Illness: A Qualitative Systematic Review of the Experiences and Perspectives of Hwabyung Patients in Korea.

Background: In the clinical field, anger has generally been studied in terms of aggressive behavior. However, in Asians, anger suppression is more common than anger expression. Hwabyung is a culture-related anger syndrome in Korea and is known to occur due to the continued repression of anger. Investigating Hwabyung should lead to a better understanding of the multiple dimensions of anger. To explore Hwabyung patients' experiences and perspectives, a meta-aggregation approach was used to conduct a systematic review and a qualitative synthesis. Methods: A systematic search was conducted in MEDLINE/PubMed, EMBASE, Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycARTICLES, and four Korean databases [Korean Medical Database (KMbase), Korean Studies Information Service System (KISS), National Digital Science Library (NDSL), and Oriental Medicine Advanced Searching Integrated System (OASIS)] in September 2020. Studies were included if they collected and analyzed qualitative data from Hwabyung patients. Qualitative research findings on the experiences and perspectives of Hwabyung patients in Korea were critically appraised and synthesized using the Joanna Briggs Institute methodology. Results: Seven eligible studies were included. The findings from those studies (i.e., theme or subtheme of qualitative research) were aggregated into categories (a group of similar findings) and synthesized findings (a group of categorized findings). Ultimately, 116 findings were aggregated into 15 categories. Finally, four synthesized findings were derived from the 15 categories: (i) anger arousal, (ii) blame, (iii) uncontrollable physical and emotional symptoms, and (iv) compromise and temporary coping. Conclusions: Patients with Hwabyung experience chronic anger through the complex cognitive processes involved in blame. Hwabyung negatively affects patients' physical, psychological, and social functions. Because Hwabyung patients feel as if they are losing control, due to emotional dysregulation and physical symptoms, professional support should be provided to facilitate their coping strategies. Further studies on Hwabyung can serve as a new model of pathological anger.

Current Status of Traditional Korean Medicine Services in Public Sector: A Study for Integrating Traditional Korean Medicine into Community Care System.

Korea is currently executing a pilot program for community care of its aging population and aims to implement community care systems on a national scale by 2025. This study examines the traditional Korean medicine (TKM) service to be provided within community care by understanding the current status of TKM services. The Ministry of Health and Welfare (MoHW) sent official letters to 242 local governments (cities, districts, and counties) from October to November 2019 to survey the status of the public TKM services provided in 2018. The items of the survey included basic demographic information as well as information that could reveal how the program was implemented. In 112 local government jurisdictions (response rate 46.3%), a total of 867 TKM service programs were in place. As a result of the survey, it was revealed that they did not have any service manuals or evaluation results. To provide home-care-based TKM service for the elderly as an integrated part of a community care system, it is necessary to develop, distribute, and evaluate a standard service manual including an evaluation index by the central government.

Aqueous green tea infusion extracted by ultra-sonication method, but not by conventional method, facilitates GLUT4 membrane translocation in adipocytes which potently ameliorates high-fat diet-induced obesity.

Green tea contains bioactive compounds, such as polyphenols, responsible for its health-promoting effects, including antiobesity and antidiabetic effects. We previously reported that ultra-sonication extraction (UE) could efficiently increase the extraction yield of green tea compounds. In the present study, we found that the extract obtained using UE contained higher phenolic and flavonoid contents than that obtained using the conventional method. We therefore considered the extract as a bioactive metabolite-rich functional green tea extract (BMF-GTE), and tested its glucose-lowering effect by generating an adipocyte cell line stably expressing 7myc-GLUT4-GFP. We found that BMF-GTE treatment increased GLUT4 translocation to the plasma membrane. Moreover, BMF-GTE administration attenuated weight gain in mice fed a high-fat diet (HFD). Importantly, HFD-induced glucose tolerance was ameliorated in the mice receiving BMF-GTE. Therefore, we conclude that BMF-GTE worked against obesity and diabetes, at least partially, by enhancing GLUT4 translocation in adipocytes. PRACTICAL APPLICATIONS: As green tea is one of the most consumed beverages worldwide, its health effects have been widely tested. In our previous studies, we found that ultra-sonication extraction (UE) has the potential to increase the aqueous extraction yield of green tea compounds compared to conventional extraction techniques. In this study, we examined the biological effect of bioactive metabolite-rich functional green tea extract (BMF-GTE) obtained using UE; we observed that administering BMF-GTE lowered the body weight and increased insulin sensitivity in mice fed a high-fat diet, potentially by facilitating the membrane translocation of GLUT4 in adipocytes. Therefore, this study suggests that the extract obtained with UE had antiobesity and antidiabetic properties, indicative of a potential application of UE in maximizing the beneficial effects of green tea on human health.

Association between dementia and depression: a retrospective study using the Korean National Health Insurance Service-National Sample Cohort database.

OBJECTIVES: Dementia is common in people over the age of 65 years, with 80% of people with dementia older than 75 years. Previous studies have linked dementia to late-life depression, but the association between dementia and mid-life depression is poorly understood. Depression is a preventable and treatable medical condition, which means it is a modifiable factor that can potentially prevent or delay dementia. This study aimed to identify the association between dementia and depression within the life course. DESIGN: A nationwide, retrospective propensity score matched cohort study associating dementia with depression. Depression diagnosed between the ages of 45 and 64 years was classified as 'mid-life' and 'late-life' if diagnosed at 65 years or older. Patients were considered to have depression when one or more International Statistical Classification of Diseases and Related Health Problems, 10th revision codes for depression were recorded as primary or secondary diagnosis. SETTING: National Health Insurance Service-National Sample Cohort database of the National Health Insurance Service in South Korea, containing patient data from 2002 to 2013. PARTICIPANTS: The study included 1824 and 374 852 patients in the case and control groups, respectively. A logistic regression analysis with complex sampling design was performed after adjusting for covariates, using the propensity score matching method without callipers, with a 1:1 nearest neighbour matching algorithm. PRIMARY AND SECONDARY OUTCOME MEASURES: The association of mid-onset and late-onset depression with dementia in terms of sociodemographic characteristics, such as sex and age, within the Korean population. RESULTS: Dementia was significantly associated with the presence of depression (OR=2.20, 95% CI=1.53-3.14); in particular, female patients with depression and patients aged 45-64 years with depression had increased odds of dementia (OR=2.65, 95% CI=1.78-3.93 and OR=2.72, 95% CI=1.41-5.24, respectively) CONCLUSION: Depression is an associated factor for dementia, especially among people aged 45-64 years (mid-life).

Effectiveness and Safety of Herbal Medicine for Atopic Dermatitis: An Overview of Systematic Reviews.

OBJECTIVES: Herbal medicine (HM) is attracting attention for treating atopic dermatitis (AD). This overview was conducted to summarize and critically evaluate the current systematic reviews (SRs) on HM for the treatment of AD. METHODS: Through comprehensive searches, all relevant SRs on HM for AD published until May 2020 were included. The quality of included SRs was assessed using the AMSTAR-2 tool. Moreover, original randomized controlled trials (RCTs) included in the SRs were resynthesized to investigate the efficacy and safety of oral HM for AD. The quality of evidence for the main findings was evaluated using the GRADE approach. RESULTS: Nine SRs were included in this overview. HM showed significantly better efficacy in terms of total effective rate (TER), itching and sleep symptom scores, quality of life, and the dose of topical treatment used compared with placebo. HM as a monotherapy and/or an adjunctive therapy to conventional medication (CM) showed significantly better results on the efficacy, symptom relief, and some laboratory parameters related to the inflammatory response. The methodological quality was generally low. When 58 original RCTs were reanalyzed, HM showed significantly lower SCORing Atopic Dermatitis (SCORAD) score and higher TER than the placebo or CM. In terms of the safety profile, HM was not significantly different from the placebo and was better than CM. The quality of evidence ranged from "moderate" to "very low." CONCLUSION: The results suggested that HM as a monotherapy or an adjunctive therapy is promising for the treatment of AD. However, due to low methodological quality and low quality of evidence, further rigorous, well-designed, high-quality SRs, and RCTs are needed to make clinical recommendations on HM use.

Perception on the Traditional Korean Medicine According to the Existence of a Chronic Disease.

OBJECTIVES: Chronic diseases (CDs) continue to increase due to advances in medicine and increase in lifespan, affecting quality of life and resulting in economic loss through treatment costs. This study addressed the perception characteristics of the effectiveness of Korean medicine (KM) based on the existence of a CD to determine the national preference for KM treatment. METHODS: Using data from the 2017 National Survey of KM Usage, we evaluated the perception on treatment effect of 16 diseases by dividing them into the CD group and the non-CD group. Response reliability was verified by applying the chi-square test (χ2-test) analysis method of the Statistical Package for the Social Sciences (SPSS) statistical program. RESULTS: The analysis of the perception on effectiveness of KM for patients with CD (n = 1,050, 21.0%) and for patients with non-CD (n = 3,950, 79.0%) showed an overall similar trend for all the 16 diseases. The response rates of having some treatment effect were high for nine diseases namely, disc-related disease (CD 70.7%, non-CD 73.1%), osteoarthritis (CD 72.3%, non-CD 72.4%), frozen shoulder and shoulder pain (CD 79.6%, non-CD 81.4%), back pain (CD 84.6%, non-CD 85.0%), sprain (CD 84.8%, non-CD 84.1%), facial nerve paralysis (CD 73.5%, non-CD 71.7%), stroke (CD 66.2%, non-CD 62.8%), digestive disease (CD 53.3%, non-CD 50.0%), and common cold and rhinitis (CD 44.7%, non-CD 44.8%). CONCLUSION: The present results found that there was little difference in the perception on effectiveness of KM for each of the 16 diseases in patients with CD and non-CD, however, 70% or more of the respondents recognized some treatment effect on musculoskeletal disorders, regardless of the existence of CD. Preferential political support for KM treatment of chronic musculoskeletal disorders is recommended.

Current Status of Management on Pharmacopuncture in Korea through Introduction of an Accreditation System.

OBJECTIVES: Pharmacopuncture is a new form of acupuncture treatment that injects herbal medicine into acupuncture points. This paper introduces the management status of pharmacopuncture through accreditation, and examines the effect of accreditation on pharmacopuncture management. METHODS: The Accreditation System of External Herbal Dispensaries (EHDs) of traditional Korean medicine clinics announced by the Ministry of Health and Welfare in September 2018 were investigated. RESULTS: The Accreditation System of EHDs assesses and certifies herbal medicine and pharmacopuncture preparations. Regular components for the 'pharmacopuncture' certification consist of nine standards, 30 categories, and 165 items. The nine standards include: herbal dispensary facilities, clean room management, management and organization operation, employee management, document management, continuous quality control, herbal medicine management, management of preparation, and pavement management. CONCLUSION: Through EHD accreditation and certification system, traditional Korean medicine clinics and EHDs can now manage pharmacopuncture medicine quality and promise safe pharmacopuncture treatment for the people.

The Utilization of Medical Devices by Traditional Korean Medicine Doctors Investigated through Traditional Korean Medicine Clinical Studies.

OBJECTIVE: The purpose of this study was to investigate the current status of modern medical devices utilized in diagnosis and treatment in traditional Korean medicine (TKM). METHODS: We searched the following six Korean electronic databases to collect TKM clinical studies that were published in a five-year period (January 2012 to December 2016). Clinical studies of TKM when medical devices were used for diagnosis or treatment were investigated. RESULTS: The search generated a total of 3,735 articles, and 1,328 of these were considered to be clinical studies. Of a total of 1,328 clinical studies of TKM, 774 articles (58.3%) used medical devices for diagnosis or treatment, and 554 articles (41.7%) did not use medical devices for diagnosis or treatment. The three most used diagnostic devices were as follows: MRI scanners, which were used in 194 (20.6%) studies; X-ray machines, which were used in 172 studies (18.3%); and CT scanners, which were used in 139 studies (14.8%). The three most used treatment devices were electroacupuncture equipment (20.3%), transcutaneous electrical nerve stimulation (TENS) equipment (18.4%), and interferential current therapy (ICT) equipment (16.4%). CONCLUSIONS: This study suggests that TKM doctors use diagnostic information derived from modern medical devices clinically. It is therefore necessary to institutionalize considering changes to the medical acts of traditional medicine (TM) doctors. Additionally, this information can be utilized as a reference for developing TM policy and education.

Evaluating integrative medicine acute stroke inpatient care in South Korea.

High demand for traditional Korean medicine led to a policy change in 2010 allowing hospitals to provide Integrative medicine care that combines Western medicine and Korean medicine. This study evaluated the effects of Integrative medicine compared to Western medicine-only for managing acute stroke in South Korean hospitals. A retrospective matched case-control observational study was conducted for acute stroke patients admitted nationwide in 2012 and 2013. Propensity score matching was used to adjust for the likelihood of selecting Integrative medicine. Hierarchical generalized linear models were used to control for patient characteristics at the episode of care (level 1) and cluster effects from the hospitals (level 2). A total of 1182 patients and 65 hospitals were matched and analyzed. Receiving Integrative medicine significantly increased the average length of stay (OR 1.27; 95% CI 1.13-1.42), total cost of inpatient care (OR 1.93; 95% CI 1.62-2.31), and per-day cost (OR 1.34; 95% CI 1.21-1.47). Receiving Integrative medicine did not affect all-cause 3-month emergency readmissions (OR 1.36; 95% CI 0.92-2.02). However, Integrative medicine was associated with a reduced risk of all-cause mortality at 3 months (OR 0.36; 90% CI 0.13-0.99) and 12 months (OR 0.34; 95% CI 0.15-0.75) after admission. Receiving Integrative medicine was associated with improved 3-month and 12-month survival, greater healthcare utilization and higher costs. Further economic evaluations are needed to guide policy for efficient integration of Korean medicine and Western medicine.

Safflower bud inhibits RANKL-induced osteoclast differentiation and prevents bone loss in ovariectomized mice.

BACKGROUND: The powder and extract of safflower seeds are known to be effective in the prevention of bone loss in ovariectomized animals. However, the inhibitory effect and molecular mechanisms of safflower bud (SB), the germinated safflower, on bone destruction is unclear. PURPOSE: The present study was designed to investigate the inhibitory effect and molecular mechanism of SB on osteoclastic differentiation and on bone loss in ovarietomized (OVX) mice. METHODS: Osteoclastogenesis was determined by TRAP staining, F-actin ring formation, and bone resorption assay. NF-κB and MAPKs activation was analyzed by transfection assay and Western blot, respectively. Real-time PCR was performed to examine the expression of osteoclastogenesis-related genes. Histological changes, increases in TRAP-positive cells, and cathepsin K expression were examined in the metaphysis of OVX mice. Density of bone marrow was evaluated by µCT. RESULTS: SB inhibited the RANKL-induced differentiation of BMDMs into osteoclasts in a dose-dependent manner. F-actin ring formation and bone resorption were also reduced by SB in RANKL-treated BMDMs. In addition, SB decreased the activation of NF-κB and MAPKs and the expression of osteoclastogenesis-related genes in BMDMs treated with RANKL. Feeding of SB-included diet prevented bone loss in OVX mice. The number of TRAP-positive cells and level of protein expression of cathepsin K was reduced and bone mineral density was increased in the metaphysis of mice fed SB compared with OVX mice. CONCLUSION: These findings suggest that SB can be a preventive and therapeutic candidate for destructive bone diseases.

Clusterin and Pycr1 alterations associate with strain and model differences in susceptibility to experimental pancreatitis.

Acute pancreatitis has several underlying etiologies, and results in consequences ranging from mild to complex multi-organ failure. The wide range of pathology suggests a genetic predisposition for progression. We compared the susceptibility to acute pancreatitis in BALB/c and FVB/N mice, coupled with proteomic analysis, in order to identify potential protein associations with pancreatitis progression. METHODS: Pancreatitis was induced in BALB/c and FVB/N mice by administration of cerulein or feeding a choline-deficient, ethionine-supplemented (CDE) diet. Histology and changes in serum amylase were examined. Proteome profiling in cerulein-treated mice was performed using 2-dimensional differential in gel electrophoresis (2D-DIGE) followed by mass spectrometry analysis and biochemical validation. RESULTS: Male and female FVB/N mice manifested more severe cerulein-induced pancreatitis as compared with BALB/c mice, but both strains were similarly susceptible to CDE-induced pancreatitis. Few of the 2D-DIGE alterations were validated by immunoblotting. Clusterin was markedly up-regulated after cerulein-induced pancreatitis in FVB/N but less-so in BALB/c mice. Pyrroline-5-carboxylate reductase (Pycr1), an enzyme involved in proline biosynthesis, had higher basal levels in FVB/N male and female mouse pancreata compared with BALB/c pancreata, and was relatively more resistant to degradation in FVB/N pancreata. However, serum and pancreas tissue proline levels were similar in the two strains. CONCLUSION: FVB/N is more susceptible than BALB/c mice to cerulein-induced but not CDE-induced pancreatitis. Most of the 2D-DIGE alterations in the two strains likely relate to posttranslational modifications rather than protein level differences. Clusterin levels increase dramatically in association with pancreatitis severity, while Pycr1 is higher in FVB/N versus BALB/c pancreata basally and after induction of pancreatitis. Changes in proline metabolism may represent a novel potential genetic modifier in the context of pancreatitis.

Utilization Patterns of Korean Medicine: An Analysis of the National Health Insurance Cohort Database from 2002 to 2013.

OBJECTIVES: Although Korean Medicine (KM) is an important part of the Korean healthcare system and plays a significant role in chronic and incurable diseases, there is insufficient information about KM utilization. The aim of the study was to identify KM utilization patterns using a national representative sample data. METHODS: KM users aged 0-80 years and older from the nationally representative sample in the National Health Insurance Service-National Sample Cohort of 778,506 KM users between 2002 and 2013 (were analyzed. Annual changes in utilization patterns were analyzed by sex, nine age groups, five income levels, and numbers of visits and hospitalizations. Utilization patterns by the type of healthcare institution and the top 10 major diseases were studied. RESULTS: Frequencies of KM use differed according to analyses of patients and claims. Women used KM 1.5 times more than did men. Patients in their 40s and 50s made up one third of KM users. In contrast to other studies, high-income groups used KM more than did low-income groups. More than 96% of ambulatory patients used mostly KM clinics, and more than 76% of inpatients used KM hospitals. Musculoskeletal disorders were the main disease treated, which conformed to the results of previous studies. CONCLUSION: The results suggest that women, people in their 40s and 50s, and people with a relatively high income use KM more often than other patients. Further comparison studies of both Western medicine in Korea and other countries should be conducted.