The Comparison of Clinical Variables Among Competitive Employment, Partial Employment, and Unemployment Group in Schizophrenic Outpatients / 신경정신의학

Objectives@#The purpose of this research was to examine differences between clinical variables among outpatients with schizophrenia in competitive and partial employed and unemployed groups. @*Methods@#The study subjects were 168 outpatients with schizophrenia, and these were divided into three groups, that is, competitive (n=20), partial (n=28), and unemployed (n=120) groups, based on employment status. Job and psychopathology data were collected by interview and using self-report questionnaires (self-stigma, will to recover, family attitude, perceived social support, insight into disease, self-esteem, hopelessness, and attitude to drugs). @*Results@#The proportion of male patients in the competitive employment group was greater than in the partial or unemployed groups. Education level was significantly higher, and the number of hospitalizations was significantly lower in the competitive group than in the unemployed group.Levels of self-stigma, will to recover, and perceived social support were significantly higher, and levels of self-esteem and hopelessness were significantly lower in the competitive and partial employment groups than in the unemployed group. Patients in these two groups also reported a more positive family attitude, more insight into the disease, and a more positive attitude toward drugs than patients in the unemployed group. @*Conclusion@#Most clinical variables were similar in the competitive and partial employment groups.The findings of this study suggest environmental and systematic factors are more important for the employment of outpatients with schizophrenia than disease-associated factors.

Opinions on the Recovery of Outpatients with Schizophrenia and Their Wills to Recover / 대한정신분열병학회지

Objectives@#To examine the opinions regarding recovery and assess their will to recover in outpatients with schizophrenia. @*Methods@#Total 98 stable outpatients with schizophrenia were enrolled. To investigate the outpatients’ opinions regarding recovery, we asked the subjects to write down the ways they could think they had recovered from their current disease. We classified their answers and chose final 39 statements. Using this questionnaire, they were asked to what extent they agreed with each statement. Moreover, the Recovery Assessment Scale (RAS) was used to measure the subjects’ will to recover. @*Results@#Many of the 39 subjects who were surveyed about their opinions on recovery agreed on 11 statements about taking medicine, social life, daily life, social functioning, positivity about life (happiness, hope, confidence, and tranquility), symptoms, occupation, and self-control. The RAS score showed a significant correlation with age (r=-0.26, p<0.01), age at onset (r=0.26, p<0.01), duration of illness (r=-0.52, p<0.01), and number of hospitalization (r=-0.46, p<0.01). @*Conclusion@#This study shows that positivity about life is an important part of the patients’ subjective recovery criteria in schizophrenia. Therefore, if clinicians pay more attention to this part of subjective recovery, it would strengthen the patients’ will for recovery.

Opinions on the Recovery of Outpatients with Schizophrenia and Their Wills to Recover / 대한정신분열병학회지

Objectives@#To examine the opinions regarding recovery and assess their will to recover in outpatients with schizophrenia. @*Methods@#Total 98 stable outpatients with schizophrenia were enrolled. To investigate the outpatients’ opinions regarding recovery, we asked the subjects to write down the ways they could think they had recovered from their current disease. We classified their answers and chose final 39 statements. Using this questionnaire, they were asked to what extent they agreed with each statement. Moreover, the Recovery Assessment Scale (RAS) was used to measure the subjects’ will to recover. @*Results@#Many of the 39 subjects who were surveyed about their opinions on recovery agreed on 11 statements about taking medicine, social life, daily life, social functioning, positivity about life (happiness, hope, confidence, and tranquility), symptoms, occupation, and self-control. The RAS score showed a significant correlation with age (r=-0.26, p<0.01), age at onset (r=0.26, p<0.01), duration of illness (r=-0.52, p<0.01), and number of hospitalization (r=-0.46, p<0.01). @*Conclusion@#This study shows that positivity about life is an important part of the patients’ subjective recovery criteria in schizophrenia. Therefore, if clinicians pay more attention to this part of subjective recovery, it would strengthen the patients’ will for recovery.

Guidelines for Laboratory Diagnosis of Coronavirus Disease 2019 (COVID-19) in Korea

The outbreak of coronavirus disease 2019 (COVID-19), which began in December 2019, is still ongoing in Korea, with >9,000 confirmed cases as of March 25, 2020. COVID-19 is a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection, and real-time reverse transcription-PCR is currently the most reliable diagnostic method for COVID-19 around the world. Korean Society for Laboratory Medicine and the Korea Centers for Disease Prevention and Control propose guidelines for diagnosing COVID-19 in clinical laboratories in Korea. These guidelines are based on other related domestic and international guidelines, as well as expert opinions and include the selection of test subjects, selection of specimens, diagnostic methods, interpretation of test results, and biosafety.

The Insight Paradox among Outpatients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: The primary objective was to test the phenomenon known as the insight paradox, which refers to the association between higher levels of insight and lower self-esteem, higher hopelessness, and a higher perception of social prejudice among patients with schizophrenia. METHODS: A total of 216 outpatients with schizophrenia according to the DSM-IV diagnostic criteria were recruited. All participants were receiving ongoing outpatient treatment and were in a stable phase of the disorder. The participants were divided into a good-insight (N=109) and a poor-insight (N=107) group by the direct interview and the mean score of questionnaire. The parameters used for analysis and comparison were demographic variables (age, gender, education), clinical variables (age at onset, number of hospitalizations), self-esteem, hopelessness, self-stigma, and quality of life. RESULTS: Compared with the poor-insight group, the good-insight group was found to have a lower number of hospitalizations, lower self-esteem, higher hopelessness, lower quality of life, and a higher level of internalized stigma. CONCLUSION: The insight can cause the negative consequences in patients with schizophrenia. Therefore, clinicians should pay attention to the negative aspects of insight for improving the quality of life in the treatment of patients with schizophrenia.

Usefulness of delta neutrophil index for early prediction of overt disseminated intravascular coagulopathy in patients with venomous snakebite

OBJECTIVE: Clinically, consumptive coagulopathy, such as disseminated intravascular coagulopathy (DIC), is the most important among the common venomous snakebite complications owing to the serious hemorrhage risk associated with this condition. We evaluated the predictive value of the delta neutrophil index (DNI)—a new indicator for immature granulocytes—for DIC diagnosis. METHODS: This retrospective observational study consecutively assessed adult patients with venomous snakebites for over 51 months. Patients were categorized into the no DIC and DIC groups. DNI values were measured within 24 hours after snakebite. RESULTS: Thirty patients (26.3%) developed DIC. The DIC group had significantly higher median initial DNI than the no DIC group (0% vs. 0.2%, P < 0.001). When the DIC group was divided into early and late groups (within and over 24 hours after snakebite, respectively), the DNI of the former was significantly higher than that of the latter and no DIC group. The late DIC group had significantly higher DNI than the no DIC group. Furthermore, DNI positively correlated with the DIC score (r=0.548, P < 0.001). The initial DNI (odds ratio, 4.449; 95% confidence interval, 1.738 to 11.388; P=0.002) was an early DIC predictor. The area under the curve based on the initial DNI’s receiver operating characteristic curve was 0.724. CONCLUSION: DNI values were significantly higher in the DIC group. Additionally, DNI was an early predictor of DIC development in patients with venomous snakebites in the emergency department.

Usefulness of serum lactate as a predictor of successful discontinuation of continuous atropine infusion in patients with severe acute organophosphate poisoning

OBJECTIVE: In severe organophosphate (OP) poisoning, administration of atropine via continuous intravenous infusion is typically considered. To date, there have been no studies on predicting successful atropine discontinuation through plasma cholinesterase (PChE) and serum lactate levels, which are monitored during critical care in severe acute OP poisoning. Therefore, we retrospectively evaluated the usefulness of serum lactate and PChE as predictors of successful discontinuation of atropine infusion. METHODS: This retrospective observational study was performed on consecutive adult patients treated for severe acute OP poisoning between March 2011 and December 2016. We sequentially evaluated serum lactate and PChE levels on emergency department arrival and before a discontinuation trial of atropine infusion. Discontinuation of atropine intravenous infusion was attempted in patients after clearance of respiratory secretions and cessation of bronchoconstriction. Discontinuation of atropine infusion attempts were divided into successful and failed trials. RESULTS: A total of 95 trials were conducted in 62 patients. Serum lactate levels before trials were significantly different between patients with successful and failed trials. The area under the curve for prediction of successful atropine discontinuation using serum lactate levels before trial discontinuation were 0.742 (95% confidence interval, 0.638 to 0.846). PChE level was not significantly different between two groups. CONCLUSION: Serum lactate levels before the discontinuation trial of atropine infusion served to predict successful discontinuation in severe acute OP poisoning.

Factors Affecting the Empowerment Experienced by Outpatients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: To identify various factors that might affect the empowerment of outpatients with schizophrenia. METHODS: Of patients who had been receiving outpatient treatments at the department of psychiatry in Dong-A university hospital, 116 patients with a DSM-IV-TR diagnosis of stable schizophrenia were enrolled in this study. The empowerment, psychiatric symptoms, social functions, insight, family attitude, social support and self-esteem were assessed through an interview or self-report measures. Overall, multiple regression analyses were performed in consideration of 11 factors (age, sex, level of education, age of onset, frequency of hospitalization, symptoms, social functions, insight, family attitude, social support, self-esteem) as explanatory variables for the empowerment. RESULTS: Multiple regression analyses using a backward elimination revealed that the following four factors were found to be significant explanatory variables for the empowerment: age of onset, social functions, family attitude and self-esteem. A coefficient of determination for these four explanatory variables was 0.65. CONCLUSION: In conclusion, the results showed that four factors, such as age of onset, social functions, family attitude and self-esteem, were found to be significant explanatory variables for the empowerment of outpatients with schizophrenia. Since these four variables accounted for 65% of total empowerment, however, further studies in a larger group of patients are warranted to identify other potential factors for the empowerment.

Comparisons of the Clinical Variables between High and Low Self-Stigma Group in the Outpatients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: The purpose of this research was to investigate the differences of clinical variables between high and low self-stigma group in the outpatients with schizophrenia. METHODS: 209 schizophrenic outpatients were assigned to high self stigma group (n=76) and low self stigma group (n=133) based on the scores of perceived stigma, and compared age, sex, education, age of onset, duration of illness, number of hospitalization, symptom, social functioning, insight, self-esteem, empowerment between two groups. RESULTS: 1) The high self-stigma group had significantly lower age of onset, higher duration of illness and number of hospitalizations compared to the low self-stigma group. 2) In the PANSS, the high self-stigma group showed significantly higher score in the total score and general symptoms compared to the low self-stigma group. No significant difference was found in the positive symptoms and negative symptoms between two groups. 3) The high self-stigma group had significantly lower empowerment and self-esteem compared to the low self-stigma group. 4) The high self-stigma group had significantly higher insight compared to the low self-stigma group. CONCLUSION: Self-stigma in patients with schizophrenia directly reduces self-esteem and empowerment, and may cause depression and a lower quality of life. Therefore, identifying self-stigma and its degree is one of the important factors for good outcome.

Supernumerary ovary on recto-sigmoid colon with associated endometriosis

A supernumerary ovary is a rare gynecological anomaly, and is usually excised due to its malignant transformation potential. We report a case of a supernumerary ovary and endometriosis situated on the anterior rectosigmoid colon. When laparoscopy was conducted, a firm, 5-cm mass was discovered on the anterior rectosigmoid colon along with normal ovaries. In this case, the discovery of a supernumerary ovary implied the presence of endometriosis. It is unusual for endometriosis and a supernumerary ovary to exist simultaneously.

Effect of Accreditation on the Accuracy of Diagnostic Hematologic Tests: Standard Deviation Index Analysis

No abstract available.

3-dimensional reconstruction of mandibular canal at the interforaminal region using micro-computed tomography in Korean

PURPOSE: The purpose of this study was to identify the complex course of the mandibular canal using 3D reconstruction of microCT images and to provide the diagram for clinicians to help them understand at the interforaminal region in Korean. MATERIALS AND METHODS: Twenty-six hemimandibles obtained from cadavers were examined using microCT, and the images were reconstructed. At both the midpoint of mental foramen and the tip of anterior loop, the bucco-lingual position, the height from the mandibular inferior border, the horizontal distance between two points, and position relative to tooth site on the mandibular canal were measured. The angle that the mental canal diverges from the mandibular canal was measured in posteriorsuperior and lateral-superior direction. RESULTS: The buccal distance from the mandibular canal was significantly much shorter than lingual distance at both the mental foramen and the tip of anterior loop. The mandibular canal at the tip of anterior loop was significantly located closer to buccal side and higher than at the mental foramen. And the mental canal most commonly diverged from the mandibular canal below the first premolar by approximately 50° posterior-superior and 41° lateral-superior direction, which had with a mean length of 5.19 mm in front of the mental foramen, and exited to the mental foramen below the second premolar. CONCLUSION: These results suggest that it could form a hazardous tetrahedron space at the interforaminal region, thus, the clinician need to pay attention to the width of a premolar tooth from the mental foramen during dental implant placement.

Factors Influencing Burden on the Primary Caregivers of Remitted Schizophrenic Outpatients / 대한정신분열병학회지

OBJECTIVES: The purpose of this study is to investigate the variables besides symptom that influence the family burden in the primary caregivers of remitted schizophrenic outpatients, and to evaluate the impact of changeable or unchangeable variables by clinical practice on the family burden. METHODS: A total 105 remitted schizophrenic outpatients and 105 their primary caregivers were participated in the psychiatric outpatient clinic of the university hospital. Socio-demographic characteristics (age, sex, education, income, marital status, religion), clinical variables (duration of illness, age of onset), patients' symptom (korean version of the positive and negative syndrome scale), patients' social function (korean version of the social functioning scale), patients' insight (self-appraisal of illness questionnaire), patients' attitude toward medication (drug attitude inventory), family perceived social support (multidimensional scale of perceived social support), family attitude toward patient (family attitude scale) were gathered from subjects. RESULTS: Total score of family burden scale (0–144) of the primary caregivers of remitted schizophrenic outpatients was 71.3 (SD 20.7) and mean score per item was 1.9. Unchangeable six variables by clinical practice (relation with patient, patients' education, age of onset, duration of illness, parent age, parent income) explain 17%, and changeable four variables (family attitude toward patient, family perceived social support, patients' social function, patients' insight) explain 72% of family burden. Four areas such as interpersonal communication, independence-performance, independence-competence, occupation/ employment explain family burden significantly in the seven areas of the social functioning scale. CONCLUSION: Primary caregivers of remitted schizophrenic outpatients feel burden considerably even though their ill relatives show few psychiatric symptoms. Changeable variables by clinical practice were more explanation than unchangeable variables on the family burden.

Factors Influencing Burden on the Primary Caregivers of Remitted Schizophrenic Outpatients / 대한정신분열병학회지

OBJECTIVES: The purpose of this study is to investigate the variables besides symptom that influence the family burden in the primary caregivers of remitted schizophrenic outpatients, and to evaluate the impact of changeable or unchangeable variables by clinical practice on the family burden. METHODS: A total 105 remitted schizophrenic outpatients and 105 their primary caregivers were participated in the psychiatric outpatient clinic of the university hospital. Socio-demographic characteristics (age, sex, education, income, marital status, religion), clinical variables (duration of illness, age of onset), patients' symptom (korean version of the positive and negative syndrome scale), patients' social function (korean version of the social functioning scale), patients' insight (self-appraisal of illness questionnaire), patients' attitude toward medication (drug attitude inventory), family perceived social support (multidimensional scale of perceived social support), family attitude toward patient (family attitude scale) were gathered from subjects. RESULTS: Total score of family burden scale (0–144) of the primary caregivers of remitted schizophrenic outpatients was 71.3 (SD 20.7) and mean score per item was 1.9. Unchangeable six variables by clinical practice (relation with patient, patients' education, age of onset, duration of illness, parent age, parent income) explain 17%, and changeable four variables (family attitude toward patient, family perceived social support, patients' social function, patients' insight) explain 72% of family burden. Four areas such as interpersonal communication, independence-performance, independence-competence, occupation/ employment explain family burden significantly in the seven areas of the social functioning scale. CONCLUSION: Primary caregivers of remitted schizophrenic outpatients feel burden considerably even though their ill relatives show few psychiatric symptoms. Changeable variables by clinical practice were more explanation than unchangeable variables on the family burden.

The Learning Curve for Laparoscopic Totally Extraperitoneal Herniorrhaphy by Logarithmic Function

PURPOSE: Totally extraperitoneal (TEP) hernia repair has gained in popularity in the past two decades. Despite the advantages TEP hernia repair, the approach is hindered by the relatively long learning curve of the surgery. We tried to estimate the necessary number of repetitions of TEP hernia repair in the learning curve using logarithmic and exponential function models. METHODS: We performed a retrospective review of all patients who underwent TEP hernia repair by a single surgeon consecutively at a single center. We calculated how many operations were needed to achieve a reduction in the expected operating time to mean operating time using logarithmic and exponential function models. RESULTS: In the 91 patients, the logarithmic function model predicted that 37 cases were needed to overcome the learning curve for TEP hernia repair while the exponential model predicted that 39 cases were needed. CONCLUSION: According to this study, at least 37 to 39 cases are needed in the overcome learning curve of TEP hernia repair. Further studies are needed to optimize surgical education and maximize quality.

Aberrant Behavior Associated with Opioid Analgesic in a Patient with Lymphoma after the Disappearance of a Tumor Causing Pain: Case Report

<p>More patients are now surviving cancer thanks to early diagnosis and improved treatment. Chronic pain in cancer survivors is problematic and the risk of chronic therapy with opioids includes abuse or addiction. We describe a patient with lymphoma whose behavior became aberrant while under treatment with opioid analgesics to manage anxiety after a painful tumor disappeared. Using opioid analgesics to manage emotional distress rather than pure physical pain has been defined as chemical coping, which is considered as an early stage of abuse or addiction. Knowledge of opioid analgesics and aberrant drug-related behaviors is necessary to manage chronic pain in cancer survivors.</p>

Taxonomic Position and Species Identity of the Cultivated Yeongji 'Ganoderma lucidum' in Korea

Ganoderma lucidum has a long history of use as a traditional medicine in Asian countries. However, the taxonomy of Ganoderma species remains controversial, since they were initially classified on the basis of their morphological characteristics. Recently, it was proposed that G. lucidum from China be renamed as G. sichuanense or G. lingzhi. In the present study, phylogenetic analysis using the internal transcribed spacer region rDNA sequences of the Ganoderma species indicated that all strains of the Korean 'G. lucidum' clustered into one group together with G. sichuanense and G. lingzhi from China. However, strains from Europe and North American, which were regarded as true G. lucidum, were positioned in a clearly different group. In addition, the average size of the basidiospores from the Korean cultivated Yeongji strains was similar to that of G. lingzhi. Based on these results, we propose that the Korean cultivated Yeongji strains of 'G. lucidum' should be renamed as G. lingzhi.

Annual Report on the External Quality Assessment Scheme for Blood Bank Tests in Korea (2015)

We report here the results of the external quality assessment scheme (EQA) of blood bank tests in Korea carried out in 2015. The proficiency testing specimens used in the survey were prepared at Ajou University Hospital. The response rates from participating laboratories for the first and second trials were 98.7% (542/549) and 98.2% (544/554), respectively. No answers to tests were considered incorrect, and the average accuracy rates for six different test items on the standard survey were as follows: ABO grouping, 99.4% to 100.0%; RhD typing, 99.4% to 100.0%; crossmatching, 93.6% to 99.0%; direct antiglobulin test (DAT) using a polyspecific reagent, 92.9% to 98.3%; DAT using an IgG monospecific reagent, 94.6% to 100.0%; DAT using a C3d monospecific reagent, 84.2% to 98.6%; unexpected antibody screening test, 94.5% to 100.0%; and antibody identification test, 93.8% to 100.0%. We performed a pilot survey on reactivities to A1 (54 responses) and H (50 responses); Rh C, c, E, and e antigen testing (47 responses); and ABO antibody titration (10-34 responses). We obtained excellent results for this EQA, and these results will be helpful for improving or maintaining the quality of the participating laboratories.

Changes in Clinical Characteristics of the Patients Who Received Endoscopic Sinus Surgery according to 10 Year Temporal Difference: A Retrospective Observational Study

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) was introduced to Korea in the 1980s and has since developed rapidly. There have been many changes in ESS over this period. Thus, in this paper, we explore trends in the clinical characteristics of ESS. SUBJECTS AND METHOD: We retrospectively reviewed patients who underwent the ESS at 000 Hospital performed by a single surgeon at a 10-year interval. By comparing 106 patients who underwent ESS in 2003 and 108 patients who underwent ESS in 2013, we investigated changes in ESS in terms of the target group of surgical indications, CT scores, range of operation and complications. RESULTS: With regard to surgical indications, the proportion of patients who underwent surgery due to nasal polyps in 2013 (32.4%) was lower than in 2003 (59.4%), while the proportion of patients undergoing fungal sinusitis surgery in 2013 (13.9%) was higher than in 2003 (0.0%). In terms of preoperative CT evaluation, Lund-Mackay scores for the maxillary sinus, ethmoid sinus, and ostiomeatal unit were lower in 2013 than in 2003. The proportion of ESS performed only in the maxillary sinus in 2013 (20.0%) was higher than in 2003 (10.0%). CONCLUSION: According to this study, the range and extent of sinusitis was favorable in 2013 compared to in 2003. The group of patients requiring treatment for only maxillary sinus disease accounted for a larger proportion of patients in 2013 than in 2003.

Discussion about 2 cases of intractable headache from brain tumor in which opioids were effective and a hypothesis regarding the underlying mechanism

Headaches caused by metastatic brain tumors result from dural tension and traction of the sites of nociceptive nerves that originates from displacement of cerebral vessels and intracranial hypertension caused by the tumor. Causes of such headaches also include meningeal irritation resulting from intrathecal dissemination of tumor and carcinomatous meningitis.Treatment of headaches resulting from intracranial hypertension involves alleviation of cerebral edema and reduction of intracranial pressure using hyperosmolar therapy and steroid administration, but treatment is often complicated by a lack of pressure reduction. We encountered 2 cases of headaches with intracranial hypertension that did not improve following hyperosmolar therapy and steroid administration, but resolved with increased opioid dose.In cases where intracranial pressure does not decrease, or for headaches attributed to direct stimulus of intracranial nociceptive nerves rather than intracranial hypertension, attempts to treat the patient with initiation or increased dosage of opioids may prove effective from a clinical standpoint.