Characterization of hidden rules linking symptoms and selection of acupoint using an artificial neural network model / 医学前沿

Comprehension of the medical diagnoses of doctors and treatment of diseases is important to understand the underlying principle in selecting appropriate acupoints. The pattern recognition process that pertains to symptoms and diseases and informs acupuncture treatment in a clinical setting was explored. A total of 232 clinical records were collected using a Charting Language program. The relationship between symptom information and selected acupoints was trained using an artificial neural network (ANN). A total of 11 hidden nodes with the highest average precision score were selected through a tenfold cross-validation. Our ANN model could predict the selected acupoints based on symptom and disease information with an average precision score of 0.865 (precision, 0.911; recall, 0.811). This model is a useful tool for diagnostic classification or pattern recognition and for the prediction and modeling of acupuncture treatment based on clinical data obtained in a real-world setting. The relationship between symptoms and selected acupoints could be systematically characterized through knowledge discovery processes, such as pattern identification.

Epidemiology and Clinical Characteristics of Enterovirus Infections in Children: A Single Center Analysis from 2006 to 2010 / 소아감염

PURPOSE: This study was performed to investigate the epidemiology of enterovirus (EV) infections in children at a secondary hospital during recent 5 years. METHODS: We collected the cerebrospinal fluid, stool and throat swab samples from the pediatric patients with suspected EV infections in KEPCO Medical Center, Seoul, Korea from July 2006 to September 2010. EV detection and genotype identification were performed by RT-PCR at Korea Centers for Disease Control and Prevention. RESULTS: A total of 386 samples were collected from 277 patients during study period. Ninety-eight patients (35.4%) were diagnosed with EV infections. The RT-PCR positive rate was the highest in throat swab samples (48.3%). The median age of patient was 4.7 years (range, 0.1-12.5 years). Aseptic meningitis (50, 51.0%) was the most common clinical manifestation; herpangina (22, 22.4%) and hand-foot-mouth disease (18, 18.4%). One hundred EVs were isolated from 98 patients and 20 genotypes of EV were identified; Echovirus 30 (28 cases, 28%), Enterovirus 71 (12 cases, 12%), Echovirus 25 (10 cases, 10%), Echovirus 9 (9 cases, 9%) and Coxsackievirus A6 (8 cases, 8%). Aseptic meningitis caused by Echovirus 30 was the most common manifestation in 2008. There was no complicated case caused by Enterovirus 71. CONCLUSION: This study showed the epidemiology of confirmed EV infection in children from 2006 to 2010. There is a need for continuous surveillance of EV infections and its clinical manifestations.

Primary mesenteric carcinoid tumor / 대한외과학회지

Primary mesenteric carcinoid tumor is very rare, although secondary mesenteric involvement is common, reported as 40% to 80%. And distant metastasis rate reported as 80% to 90%, when the size is larger than 2 cm. We present a case of very rare primary mesenteric carcinoid tumor showing benign character though large size. The patient visited St. Vincent's Hospital, The Catholic University of Korea with increasing palpable abdominal mass. At laparotomy, a well encapsulated mass arising from the mesentery near the ligament of Treitz was found without any adjacent organ invasion or distant metastasis. The mass was measured as 8.2 x 7.3 cm and histopathologically benign character. At 11 months of follow up, the patient was recurrence free.

Band Slippage after Laparoscopic Adjustable Gastric Banding (LAGB)

Laparoscopic adjustable gastric banding (LAGB) has proved to be safe and effective, worldwide. The perigastric technique was once the most frequent method of band placement, but posterior prolapse was a problem. The introduction of the pars flaccida technique has considerably reduced the incidence of this complication, and, currently, this technique is the most utilized method and recommended by most bariatric surgeons. However, LAGB with pars flaccida technique has rare complications such as band slippage and gastric pouch dilatation in 2~5% of patients. We have experienced 2 band replacement cases for band slippage and pouch dilatation each happening about 1 and 2 years after LAGB.

Elder Abuse

Just these days elder abuse receives increasing social attention even though Korea already entered the ageing society with the steep increase of elderly population and this causes many social problems including elderly suicides. We need to develop methods to deal with these severe social problems, but, owing to lack of reliable data and studies, it is even difficult to document actual conditions of elder maltreatment. In a Korean nationwide epidemiological study conducted in 2007, the prevalence rate of elder abuse for last one year was 6.0%. Emotional abuse showed the highest prevalence (5.2%), and followed by neglect (2.3%), physical abuse (0.2%). The purpose of this study is to investigate the current prevalence and condition of elder maltreatment and provide the information about concept, types, risk factors and intervention of elder maltreatment.

Elder Abuse

Just these days elder abuse receives increasing social attention even though Korea already entered the ageing society with the steep increase of elderly population and this causes many social problems including elderly suicides. We need to develop methods to deal with these severe social problems, but, owing to lack of reliable data and studies, it is even difficult to document actual conditions of elder maltreatment. In a Korean nationwide epidemiological study conducted in 2007, the prevalence rate of elder abuse for last one year was 6.0%. Emotional abuse showed the highest prevalence (5.2%), and followed by neglect (2.3%), physical abuse (0.2%). The purpose of this study is to investigate the current prevalence and condition of elder maltreatment and provide the information about concept, types, risk factors and intervention of elder maltreatment.

A Case of Adrenocortical Oncocytoma Misrecognized for Fibrolamellar Hepatocellular Carcinoma

Adrenocortical oncocytoma is a very rare disease which has been reported in 40 cases. A 27-years-old female patient was admitted for a suspicious hepatocellular mass on ultrasonogram. On CT scan, sono-guided needle biopsy and 18F-FDG PET scan, all results were unsatisfactory. During laparotomy, the mass was originated from Rt. adrenal gland and liver was pushed sideward by the mass. On pathology report, an adrenocortical oncocytoma was diagnosed. Adrenocortical oncocytoma has pathological characteristics comprised of oncocytes with granular, eosinophilic cytoplasm, and sufficient mitochondria in their cytoplasm. There were no established criteria for differential diagnose between benign and malignant adrenocortical oncocytoma. There are no sufficient data for the long-term outcome of adrenocortical oncocytoma in the medical literature. Thus we report a case of adrenocortical oncocytoma with review of the related literature.

Laparoscopic Hiatal Hernia Repair during Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) / 대한내시경복강경외과학회지

Obesity is one of the most significant causes of GERD. Nissen fundoplication is a surgical procedure that's performed world widely for treating patients with GERD and a hiatal hernia and who are intractable to medical therapy. However, Nissen fundoplication may have technical difficulties in morbidly obese patients due to the huge perigastric, intraabdominal fat tissue and hepatomegaly. During the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) procedure, the stomach was divided into the gastric pouch and the remnant stomach by vertiacally stapling at the angle of His. The posterior gastric wall and hiatus were easily exposed even when there was huge deposits of perigatric and intraabdominal fat tissue. We report here on a case of concomitant hiatal hernia repair with LRYGB in a morbidly obese patient.

Initial Experience with Bariatric Surgery in Korea: 120 Cases (LRYGB and LAGB) / 대한내시경복강경외과학회지

PURPOSE: Obesity has become a global epidemic disease, and bariatric surgery is now being increasingly performed in Korea as well as in western countries. Bariatric surgery has been performed in Korea since 2003. However, there is no data on cases of Korean bariatric surgery regarding the weight loss as well as the factors associated with the surgical outcome. METHODS: 120 total cases of bariatric surgery [LRYGB=48, LAGB=72] were done at St. Mary's Hospital. We retrospectively reviewed the series of bariatric cases and we analyzed the surgical outcome, the complications and the clinical factors associated with the surgical outcomes. RESULTS: There were no significant differences in age, BMI and pre-existing comorbidities for both procedures. The percentage of excess weight loss (%EWL) of the LRYGB at 6, 12 and 24 months was 63.8%, 73.7% and 87.5%, respectively, and the %EWL of the LAGB was 33.4%, 44.7% and 43.8%, respectively. Factors such age and gender were not associated with the surgical outcome. Yet the initial BMI tended to affect the surgical outcome. CONCLUSION: The results of our study indicate that LRYGB and LAGB are technically feasible and safe procedures. Both are quite satisfactory and promising procedures for loosing a significant amount of weight.

Korean Elderly Long-term Care Insurance System and Long-term Care Hospital

Korea is becoming aging society and the number of the aged who need long-term care service is increasing. Korean Elderly Long-Term Care Insurance System will be newly adopted soon and to make the system work successfully, comprehensive evaluation and management by professionals with have knowledge of geriatrics is necessary. In addition, long-term care hospitals should play their role between medical services and nursing care facilities as central organizations and form mutual system. The new insurance system only focuses on nursing care without regards of above facts. Other problems of it will be discussed in this study.

Clinical features and prognostic factors in Korean patients hospitalized for coronary artery disease (Catholic Heart Care Network Study) / 대한내과학회지

BACKGROUND: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. METHODS: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. RESULTS: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8+/-12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). CONCLUSIONS: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.

Clinical Review of Dementia Inpatients in Geriatric Hospital: Focused on the Change in Cognitive Function According to the Vascular Risk Factors

BACKGROUND: Recent studies have shown that vascular risk factors may involved in Alzheimer's disease as well as vascular dementia. The main purpose of our study is to review the clinical characteristics of dementia inpatients and to investigate how much vascular risk factors influence the cognition of dementia inpatients for 1 year. METHODS: Between July and August in 2004, 69 dementia inpatients meeting DSM-IV criteria were examined with reviewing their charts carefully and inteviewing them directly. MMSE-K(Mini-Mental State Examination-Korean version) was used to evaluate the cognitive function of dementia inpatients. Vascular risk factors included in this study were DM, hypertension, cholesterol, homocysteine, Apolipoprotein E. RESULTS: Of the 69 dementia inpatients, 33 cases were Alzheimer's disease, 18 cases vascular dementia, 7 cases mixed dementia, 5 cases alcoholic dementia, 5 cases dementia due to brain trauma and 1 case parkinson's disease with dementia, respectively. The mean MMSE-K scores of dementia inpatients were 10.7 points at the time of admission and 9.4 points after about 1 year. Average annual rate of decline in the MMSE-K was 2.2 points in dementia inpatients with Alzheimer Disease. In comparison between dementia inpatients with vascular risk factors(DM, hypertension, cholesterol, homocysteine, APOE epsilon4 genotype) and those without vascular risk factors, there were no differences in average annual rates of decline in the MMSE-K between two groups at each vascular risk factor. According to the presence of APOE epsilon4 genotype, in spite of no difference in age, there was significant difference in the mean MMSE-K scores between two groups at the time of admission. CONCLUSION: These results suggest that Vascular risk factors(DM, hypertension, cholesterol, homocysteine, APOE epsilon4 genotype) do not influence the rates of decline in cognition of dementia inpatients significantly.

Clinical Review of Dementia Inpatients in Geriatric Hospital: Focused on the Change in Cognitive Function According to the Vascular Risk Factors

BACKGROUND: Recent studies have shown that vascular risk factors may involved in Alzheimer's disease as well as vascular dementia. The main purpose of our study is to review the clinical characteristics of dementia inpatients and to investigate how much vascular risk factors influence the cognition of dementia inpatients for 1 year. METHODS: Between July and August in 2004, 69 dementia inpatients meeting DSM-IV criteria were examined with reviewing their charts carefully and inteviewing them directly. MMSE-K(Mini-Mental State Examination-Korean version) was used to evaluate the cognitive function of dementia inpatients. Vascular risk factors included in this study were DM, hypertension, cholesterol, homocysteine, Apolipoprotein E. RESULTS: Of the 69 dementia inpatients, 33 cases were Alzheimer's disease, 18 cases vascular dementia, 7 cases mixed dementia, 5 cases alcoholic dementia, 5 cases dementia due to brain trauma and 1 case parkinson's disease with dementia, respectively. The mean MMSE-K scores of dementia inpatients were 10.7 points at the time of admission and 9.4 points after about 1 year. Average annual rate of decline in the MMSE-K was 2.2 points in dementia inpatients with Alzheimer Disease. In comparison between dementia inpatients with vascular risk factors(DM, hypertension, cholesterol, homocysteine, APOE epsilon4 genotype) and those without vascular risk factors, there were no differences in average annual rates of decline in the MMSE-K between two groups at each vascular risk factor. According to the presence of APOE epsilon4 genotype, in spite of no difference in age, there was significant difference in the mean MMSE-K scores between two groups at the time of admission. CONCLUSION: These results suggest that Vascular risk factors(DM, hypertension, cholesterol, homocysteine, APOE epsilon4 genotype) do not influence the rates of decline in cognition of dementia inpatients significantly.

Impairment of Right Ventricular Diastolic Function in Early Type 2 Diabetes

BACKGROUND AND OBJECTIVES: Diabetes is associated with a unique form of cardiomyopathy in the absence of atherosclerosis. The mechanisms of diabetic cardiomyopathy have not been defined, but is associated with early left ventricular (LV) diastolic dysfunction following an altered LV contractile performance. However, less attention has been paid to the right ventricular (RV) diastolic function in diabetes. Therefore, the changes in the RV ans LV filling dynamics, in patients with early type 2 diabetes, were investigated. SUBJECTS AND METHODS: The transtricuspid and trans-mitral flows were assessed by transthoracic Doppler echocardiography, at maximal inspiration and expiration, in 48 subjects (mean age: 62+/-9 years, M:F=16:32) with type 2 diabetes (Type 2 DM group) and 34 normal subjects (control group ; mean age:59+/-9 years, M:F=15:19, ranging from 45-75 years of age) with normal LV systolic function and ECG at rest. Subjects with diabetic complication, nephropathy (Cr >1.5 mg/dL), LVH and COPD were excluded. RESULTS: The mitral E/A ratio and DT (deceleration time) showed no significant difference between the type 2 DM and control groups. The LV and RV systolic functions also showed no significant difference between the two groups. However, the type 2 DM group had a lower tricuspid E/A ratio (0.98+/-0.25 vs. 1.17+/-0.21, p<0.001) and a longer tricuspid DT (241+/-65 msec vs. 208+/-51 msec, p=0.016) than the control group. CONCLUSION: The right ventricular diastolic function is frequently abnormal in early type 2 diabetes. This suggests that right ventricular diastolic dysfunction may be an important predictor for the early detection of diabetic cardiomyopathy.

Sex Differences in Early Management of Patients with Acute Myocardial Infarction (AMI) in the 1990s

BACKGROUND AND OBJECTIVES: Previous studies have suggested that women with AMI are less aggressively managed than men. The aim of this study was to assess the differences between the sexes, in terms of the medical and invasive coronary procedures, in AMI patients during the 1990s, and the association to in-hospital mortality. SUBJECTS AND METHODS: In 1758 AMI patients, the baseline clinical characteristics, initial management and in-hospital outcomes, were studied. RESULTS: The women, on average, were older than men (68.8+/-10.6 versus 59.2+/-12.3, p<0.01), with a higher prevalence of diabetes and hypertension. Women received heparin and b-blockers less often than men. The unadjusted rates of thrombolysis, angiography and PTCA use were lower in women than men, but not after covariate adjustment. The in-hospital mortality was higher in women than men (11.7% versus 8.1%, odd ratio (OR) 1.51, 95% CI 1.09 to 2.11, p<0.05), but this difference was not significant after adjustment for age (adjusted OR 0.98, 95% CI 0.69 to 1.40, p=NS). CONCLUSION: Women with AMI are less aggressively managed than men, and have higher in-hospital mortalities. The difference in outcome seems to be associated with increased age, with a greater co-morbidity of women.

Assessing the degree of evidence based therapeutic intervention in a university based family medicine outpatient clinic

No abstract available.

Morphologic Differences of Vessel Wall at Sites of Focal and Diffuse Coronary Vasospasm by Intravascular Ultrasound(IVUS)

BACKGROUND AND OBJECTIVES: The coronary vasospasm has been shown to play an important role in the pathogenesis of not only variant angina but also ischemic heart disease in general, including other forms of angina pectoris, acute myocardial infarct, and sudden death. The angiographic features of coronary vasospasm are focal and diffuse patterns in clinical setting. We attempted to clarify the differences in vessel wall morphologic appearance between the sites of focal and diffuse vasospasm by intravascular ultrasound(IVUS). MATERIAL AND METHODS: We studied 23 patients(32 segments) with variant angina in whom coronary angiograms were normal and coronary spasm was documented by intracoronary injection of acetylcholine. Coronary spasm was defined as luminal diameter reduction > or = 90% compared with baseline coronary artery diameter. Focal spasm was defined if the length of spastic narrowing was less than 10mm. By IVUS, we observed atheromatous plaques in 32 spasm segments with either focal or diffuse vasospasm. We measured maximal intimal thickness, luminal cross-sectional area(CSA), and external elastic membrane-CSA in spasm sites. RESULT: When comparing maximal intimal thickness between focal (n=15) and diffuse vasospasm segments(n=17), there was significantly greater thickness at focal spasm segments(1.21+/-0.36mm vs. 0.70+/-0.23mm, P<0.001). The maximal plaque area was similar between two groups but tended to be greater in focal spasm segments(6.03+/-2.06mm2 vs. 4.92+/-2.59mm2, P=NS). When circular shaped factor(CSF : standardized index of eccentricity) was compared, focal spasm segments were greater than diffuse spasm segments(0.89+/-0.06 vs. 0.97+/-0.02, P<0.001). At the segments of focal spasm, remodeling index was greater compared to the segments of diffuse spasm(1.02+/-0.16 vs. 0.86+/-0.13, P<0.001). CONCLUSION: Focal spasm segments were more eccentric and had greater atheromatous plaque than diffuse spasm segments. Positive remodeling pattern was observed at the segments of focal spasm and negative remodeling pattern at the segments of diffuse spasm. There were morphologic differences of vessel wall appearance between focal and diffuse spasm sites.

Prevalence of early renal damage between dippers and non-dippers in mild to moderate Korean hypertensives / 대한내과학회지

BACKGROUND: Non-dipper hypertension is defined as an improper nocturnal blood pressure falling less than 10/5 mmgHg or 10% in systolic and diastolic. Clinical studies have shown that target organ damages tend to be more frequent in non-dipper hypertensives. Author tried to elucidate whether non-dippers in untreated mild to moderate hypertension has more evidence of early renal damage or not. METHODS: Total 141 untreated mild to moderate Korean essential hypertensives including borderline hypertensives and 47 controls were subjected. Diabetes, chronic renal failure, heart failure, severe hypertension (above stage-III by JNC-VI criteria), isolated systolic hypertension and macroproteinuric cases (UAER >200 microgram/mL/min) were excluded to profit this study purpose. Subject was defined as non-dipper when nocturnal blood pressure fall was less than 10/5 mmHg. Urine microalbumin was analyzed by radioimmunoassay, and their excretion rate was calculated according to 24 hr urine volume. All data were compared and analyzed statistically by using of SPSS package. RESULT: Prevalence of non-dipper is not different between both groups (hypertension vs control ; 21.3% vs 25.5%, p>0.05). In hypertensive group, incidence of significant UAER and mean UAER were not different between dipper and non-dipper (all p>0.05). CONCLUSION: In this study, evidence of early renal damage in non-dipper hypertensive was not differ from dipper hypertensives. Long-term study would be necessary to observe for further renal damage in non-dipper hypertensives.

Williams Syndrome with Megacoronary Artery

Supravalvular aortic stenosis is a rare cause of left ventricular outflow obstruction in adults. It occurs as an isolated defect sporadically or as a hereditary basis with an autosomal dominant trait without further phenotypical anomalies, or as a part of the Williams syndrome with mental retardation and multiple anomalies. In this report, we present a case of williams syndome associated with megacoronary artery.

Effect of Changes in Pulmonary Venous Flow Pattern by Preload Reduction on Distinguishing Pseudonormal Pattern from Normal

BACKGROUND AND OBJECTIVES: The degree of diastolic dysfunction may explain the difference in clinical symptoms between patients with similar degrees of systolic dysfunction. Pseudonormal mitral filling pattern with increased left ventricular filling pressure is a transitional stage of diastolic dysfunction and is difficult to distinguish from normal. Preload is one of factors affecting the diastolic filling patterns and mitral flow patterns may be influenced by changes in preload in the absence of changes in the left ventricular pressure-volume curve. The changes in the mitral flow velocities caused by preload reduction may be useful in distinguishing patients with a pseudonormal pattern from those with normal. The aim of this study was to establish whether the effect of changes in pulmonary venous flow pattern by preload reduction may be useful in distinguishing pseudonormal pattern from normal. MATERIALS AND METHODS: This study included 40 patients (men 25, female 15, average age 51.0+/-11.2 years) underwent left side cardiac catheterization among patients with normal or pseudonormal patterns. All patients with pseudonormal group had increased LVEDPr (>15 mmHg). The Doppler mitral inflow & pulmonary venous flow parameters at baseline and during reduction of preload using Valsalva maneuver were recorded. RESULTS: 1) There were no difference in sex, diabetes mellitus, hypertension and lipid profiles between both groups. The left ventricular systolic function was better and mean age was younger in normal than pseudonormal group (p 1.0 during Valsalva maneuver in normal group (p<0.05). In pseudonormal group, E velocity was significantly decreased but A velocity was not significantly changed and the E/A ratio was <1.0 during Valsalva (p<0.05). Therefore the change revealed masked LV relaxation abnormality pattern. 3) S and D velocities of pulmonary venous flow were significantly decreased and S/D ratio was significantly increased in both groups (p<0.05). The % changes before and after Valsalva maneuver showed that S velocity was less decreased, D velocity was more decreased and S/D ratio was more significantly increased in pseudonormal than normal group (p<0.05). That revealed masked LV relaxation abnormality pattern. CONCLUSIONS: The Valsalva maneuver for preload reduction is a relatively simple, easily applicable, safe and reproducible method of acutely reducing venous return. The assessment of changes in pulmonary venous flow pattern by preload reduction may be helpful in distinguishing pseudonormal and normal diastolic function in addition to changes in mitral inflow pattern.