Neutrophil-Lymphocyte Ratio as Inflammatory Marker for Delirium:An Exploratory Study / 정신신체의학

Objectives@#：Delirium is a temporary brain dysfunction and systemic inflammation is important factor in its pathophysiology. Whether the neutrophil-lymphocyte ratio (NLR), one of the inflammatory markers, can be used as an inflammatory marker in delirium patients was investigated in comparison with C-reactive protein (CRP). @*Methods@#：We retrospectively reviewed the medical records of patients who were referred for consultation for delirium at hospital for one year. The NLR and CRP values at admission and delirium status were divided into the medical and the surgical treatment group, and the interaction between them was analyzed through repeated mea-sures ANOVA. @*Results@#：NLR was maintained without significant difference before and after delirium in the medical treat-ment group and the surgical treatment group, but CRP decreased in the medical treatment group and increased in the surgical treatment group during delirium, showing a significant interaction. @*Conclusions@#：In delirium patients, the NLR remained constant, but the CRP differed according to the treatment group and the delirium state. This suggests the possibility that NLR could be used complementary to CRP as an in-flammatory marker in delirium patients.

Mycoplasma pneumoniae-associated Hepatitis without Lung Involvement / 대한소화기학회지

Mycoplasma pneumoniae (M. pneumoniae) is a major cause of community acquired respiratory infections. And it also causes a number of extrapulmonary manifestations including cardiovascular, dermatological, musculoskeletal, and hematological systems. But, acute hepatitis without lung involvement is rare in adults. Here, we report a case of 32-year-old man who presented with fever, chilling, myalgia, and headache. Biochemical analysis showed severely impaired liver function and leukopenia. Laboratory tests and liver biopsy demonstrated a hepatocellular pattern of M. pneumoniae-associated acute hepatitis. Clinical symptoms and laboratory parameters are improved rapidly under treatment with macrolide. Therefore, We recommend that phsycians should consider a possibility of M. pneumoniae infection in acute hepatitis without lung and extrapulmonary involvement, when other more frequent causes have been excluded.

Differences of Obstetric Complications and Clinical Characteristics between Autism Spectrum Disorder and Intellectual Disability / 정신신체의학

OBJECTIVES: Since the awareness of autism spectrum disorders(ASD) is growing, as a result, it is increasing numbers of infants and toddlers being referred to specialized clinics for a differential diagnosis and the importance of early autism spectrum disorders detection is emphasized. This study is to know the difference between ASD and intellectual disability(ID) from comparison of the demographics, clinical characters and obstetric complications. METHODS: The participants are 816 toddlers who visited the developmental delay clinic(DDC) in National Health Insurance Ilsan hospital. The number of toddlers diagnosed as ASD and ID was 324 and 492. 75 toddlers out of 114 who returned to DDC were diagnosed as ID at the first visit but 7 of them had changed diagnosis to ASD at the second visit. After compared ASD with ID from the first visit, we analyzed characters of toddlers who had the changed diagnosis to ASD at the second visit. RESULTS: As a result, the comparison between ASD and ID at the first visit shows that the boys have higher ratio, lower obstetric complication and lower language assessment score in ASD. The toddlers who had the changed diagnosis at the second visit were all boys and they had more cases of family history of developmental delay and had lower score of receptive language developmental quotient. CONCLUSIONS: These findings suggest that sex, language characteristics and obstetric complication could be useful in the early detection of ASD.

The Differences in Clinical Aspect Between Specific Language Impairment and Global Developmental Delay

OBJECTIVE: To compare and analyze the clinical characteristics of children with delayed language acquisition due to two different diagnoses, which were specific language impairment (SLI, a primarily delayed language development) and global developmental delay (GDD, a language delay related to cognitive impairment). METHODS: Among 1,598 children who had visited the developmental delay clinic from March 2005 to February 2011, 467 children who were diagnosed with GDD and 183 children who were diagnosed with SLI were included in this study. All children were questioned about past, family, and developmental history, and their language competences and cognitive function were assessed. Some children got electroencephalography (EEG), in case of need. RESULTS: The presence of the perinatal risk factors showed no difference in two groups. In the children with GDD, they had more delayed acquisition of independent walking and more frequent EEG abnormalities compared with the children with SLI (p<0.01). The positive family history of delayed language development was more prevalent in children with SLI (p<0.01). In areas of language ability, the quotient of receptive language and expressive language did not show any meaningful statistical differences between the two groups. Analyzing in each group, the receptive language quotient was higher than expressive language quotient in both group (p<0.01). In the GDD group, the Bayley Scales of Infant Development II (BSID-II) showed a marked low mental and motor quotient while the Wechsler Intelligence Scale showed low verbal and nonverbal IQ. In the SLI group, the BSID-II and Wechsler Intelligence Scale showed low scores in mental area and verbal IQ but sparing motor area and nonverbal IQ. CONCLUSION: The linguistic profiles of children with language delay could not differentiate between SLI and GDD. The clinicians needed to be aware of these developmental issues, and history taking and clinical evaluation, including cognitive assessment, could be helpful to diagnose adequately and set the treatment plan for each child.

A Case of IgG4-Related Sclerosing Mesenteritis Associated with Crohn's Disease / 대한소화기학회지

Sclerosing mesenteritis (SM) is a rare disease characterized by chronic nonspecific mesenteric inflammation and fibrosis of unknown etiology. Some tumefactive SM shows diffuse accumulation of IgG4-positive plasma cells and is considered as a part of the spectrum of IgG4-related disease. An association between inflammatory bowel disease and IgG4-related disease has been indicated. A 45-year-old woman visited our hospital due to weight loss with intermittent lower abdominal discomfort. Pelvic ultrasound revealed a mass-like lesion in the abdominal wall and pelvis MRI demonstrated a 5.9 cm sized wall-enhancing mass with heterogeneous signal intensity from right adnexa to the abdominal wall. Tumor resection and adhesiolysis was done because of severe adhesion with the small bowel, colon, bladder, uterus, and abdominal wall. Appendectomy was also performed due to adhesion and edematous change. Histological examination of the resected mass showed findings that were compatible with IgG4-related SM. The resected appendix showed chronic granulomatous inflammation without evidence of tuberculosis. She was diagnosed with Crohn's disease after undergoing colonoscopy and CT enterography. Herein, we report a rare case of IgG4-related SM that occurred in conjunction with Crohn's disease.

The Reliability and Validity of the Korean Version of Apathy Evaluation Scale and its Application in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: Apathy Evaluation Scale (AES) is one of the most frequently used scales to evaluate apathy. The purpose of this study was to evaluate the reliability and validity of the Korean version of the AES (K-AES) and to apply the K-AES in examining the characteristics of apathy in the Korean patients with schizophrenia. METHODS: 129 healthy people and 29 patients with schizophrenia have been evaluated using the K-AES, Physical Anhedonia Scale (PAS), Social Anhedonia Scale (SAS), and the Beck's Depression Inventory (BDI). Split-half reliability and internal consistency were evaluated and factor analysis and correlation analysis was conducted. Between-group comparison was conducted using independent sample t-tests. RESULTS: K-AES showed good reliability and validity. Factor analysis confirmed 3 factors, which represented interest and drive, initiative, self-awareness and self-assessment. Patients with schizophrenia showed significantly higher K-AES and BDI scores than the healthy group. K-AES scores in patients with schizophrenia were significantly correlated with the PAS score, but did not correlate with SAS and BDI scores. CONCLUSION: This study demonstrates the reliability and validity of the K-AES. Our findings also suggest that the K-AES may be a reliable instrument in assessing apathy as a negative symptom in patients with schizophrenia.

What is the real practice of exercise echocardiographic testing in asymptomatic patients with severe aortic stenosis? / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although exercise testing has been suggested to help predict clinical outcome, limited data are available to guide how exercise Doppler echocardiography (ECG) can be used clinically in asymptomatic patients with aortic stenosis (AS). The aim of this study was to assess the clinical value of exercise echocardiographic testing in asymptomatic patients with severe AS.</p><p><b>METHODS</b>Symptom-limited treadmill exercise testing using the modified Bruce protocol was performed in 31 asymptomatic patients (mean age (62 ± 11) years) with severe AS (aortic valve area <1 cm(2), peak aortic velocity (AV Vmax) >4 m/sec, or a mean transaortic pressure gradient (AV mean PG) >40 mmHg (1 mmHg = 0.133 kPa)) with normal left ventricular (LV) systolic function (LV ejection fraction (EF) >50%). Clinical symptoms, vital signs, ECG, and Doppler hemodynamics were obtained during and/or immediately after exercise.</p><p><b>RESULTS</b>Aortic valve replacement (AVR) was performed in 18 patients during follow-up. The patients who had AVR exhibited higher baseline AV mean PG (51 (35-84) vs. 44 (25.2-57.0) mmHg; P = 0.031). There were no significant differences between the AVR group and non-AVR group including exercise duration (7.47 (2.32-11.59) vs. 7.25 (4.06-10.52) minutes, P = 0.917), exercise capacity (10.1 (4.6-12.8) vs. 10.1 (7.0-12.8) metabolic equivalents, P = 0.675), and an increment in AV mean PG by exercise (18.5 (3.2-48.0) vs. 12.6 (4.4-32.1) mmHg, P = 0.366). Univariate regression analysis revealed that independent determinant of AVR was the baseline AV mean PG (P = 0.031).</p><p><b>CONCLUSIONS</b>Although additional value of exercise ECG was demonstrated, baseline transaortic mean pressure gradient is the major determinant of AVR. Further large-scale prospective studies are required to determine whether surgery should be recommended in the presence of an abnormal exercise ECG in asymptomatic severe AS.</p>

A Case of Left Adrenal Gland Metastatic Cancer Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Aspiration

With widespread use of imaging techniques, the discovery of adrenal incidentalomas is increasing recently. Benign tumors are more frequent than malignant tumors in adrenal incidentalomas. Among malignant adrenal incidentalomas, metastatic neoplasms are the most common etiology. Traditional techniques to obtain tissue of adrenal gland include percutaneous approach under computed tomography or abdominal ultrasound guidance as well as open or laparoscopic adrenalectomies. They are invasive and associated with considerable complications such as pneumothorax, pancreatitis, adrenal abscesses, bacteremia, needle-tract metastases, and hemorrhage. Currently, endo scopic ultrasound-guided fine needle aspiration (EUS-FNA) is increasingly used to obtain tissue for diagnosis if the lesion is located in close proximity to the gut lumen. Compared with the traditional percutaneous techniques of tissue acquisition, EUS-FNA has many advantages including less invasiveness and lower complication rate. Here, we report a case of metastatic non-small cell carcinoma of left adrenal gland diagnosed by EUS-FNA with a review of literature.

Suicidal Behavior and Internet Use in Adolescent Depression / 대한정신약물학회지

OBJECTIVE: Suicide is the leading cause of death for adolescents. The internet is widespread in Korea and has influence on mental health of adolescents. This study aims to investigate the relationship between the internet use and suicidal behavior resulting from adolescent depression. METHODS: The subjects consisted of 61 adolescents between the ages of 13 and 18 who were diagnosed as depression by Kiddie-Schedule for Affective Disorder and Schizophrenia Present and Lifetime Korean Version and Diagnostic and Statistical Manual of Mental Disorder 4th edition. Suicidal behavior was assessed by Columbia Suicide Severity Rating Scale. Patients were inquired about their internet use using questionnaires and other clinical variables using Beck Depression Inventory, Beck Suicidal Ideation Scale, Revised Children's Manifest Anxiety Scale, Internet Game Addiction Scale and Physical Abuse Scale. RESULTS: The patients within the high-risk group were more prone to searching for the word 'suicide' on the internet and having suicidal idea compare to the patients within the low-risk group. Among the high-risk group, the patients who searched for the word 'suicide' tended to be more anxious compared to the patients who did not search the word. CONCLUSION: The results of the present study suggest that searching the word 'suicide' on the internet is associated with suicidal idea. It is suggested that intervention on the patients within the searching group may reduce the suicidal idea resulting from adolescent depression.

Physiological Functionality and Enzyme Activity of Biomass from Pichia anomala Grown on Ginseng-Steaming Effluent

A novel biomass was prepared from Pichia anomala KCCM 11473, which grew well in ginseng-steaming effluent (GSE), and its physiological functionalities and enzyme activities were determined. When the strain was cultured in the GSE (pH 6.0) at 30degrees C for 48 h, 1.6 mg of biomass per ml-cultures was produced. The cell-free extract of the biomass showed high antihypertensive angiotensin I-converting enzyme inhibitory activity of 72.0% and anticholesteromia HMG-CoA reductase inhibitory activity of 46.5%. The cell-free extract also showed 13.0 U per ml and 8.5 U per ml of neutral protease activity and alkaline protease, respectively.

Emotional and Behavioral Factors Relating Adolescent Delinquency in Community / 신경정신의학

OBJECTIVES: This study aimed to investigate predictive emotional and behavioral factors of adolescent delinquents among students. METHODS: We assessed and analyzed 1377 students aged 13-18 using the following instruments: Center for Epidemiologic Study for Depression (CES-D), Revised Children's Manifest Anxiety Scale (RCMAS), Youth Self Report (YSR), Psychological self-1 of Offer's Self Image Questionnaire (PS-1 of OSIQ) and Suicide Ideation Questionnaire (SIQ). With collected data we compared the delinquent group with the control group. RESULTS: The prevalence of delinquent adolescents was 4.7%. The prevalence among of high school students was higher (8.7%) than that of middle school students (3.4%). Comparing with the control group, delinquent group showed significantly higher scores of CES-D (Delinquent 25.55 vs Control 13.07), RCMAS (Delinquent 15.60 vs Control 9.17), PS-1 of OSIQ (Delinquent 33.70 vs Control 28.87), SIQ (Delinquent 88.89 vs Control 46.89) and all subscales of YSR. Adolescent delinquency can be predicted in the order of RCMAS, Somatic complaints, CES-D and Withdrawn. CONCLUSION: We found that both emotional and behavioral factors could predict adolescent delinquency in school community. Most potent predictor was anxiety. Additional predictors were neurotic characteristics such as somatic complaints, depressive symptoms and social withdrawal. It is hypothesized that early intervention of adolescent neuroticism may be able to prevent adolescent delinquency.

Maternal Depression and Anxiety and Ratings of Behavioral Problems of Child / 신경정신의학

OBJECTIVES: This study was aimed to investigate the relationship between maternal depression and anxiety, and their ratings of child's behavior. METHODS: 769 elementary school students participated in this study. Mothers completed the Korean Conners' Parent Rating Scale (K-CPRS), the Korean Attention-deficit/hyperactivity disorder Rating Scale (K-ARS): Home Version, the Korean Beck Depression Inventory (K-BDI) and the Korean Beck Anxiety Inventory (K-BAI). Teachers completed the Korean Conners' Teacher Rating Scale (K-CTRS) and the K-ARS: School Version. The maternal emotional status was classified into four groups (Normal, Anxious and Not Depressed, Depressed and Not Anxious, Anxious and Depressed) according to BDI and BAI scores. The subscale raw scores of K-CPRS, and K-ARS: Home version were compared among maternal emotional status by the Analysis of Covariance before and after their scores were controlled for the each subscale scores rated by teachers consistent with those rated by parents. RESULTS: All of the subscale scores of parent's form were significantly different according to maternal emotional status after controlled for the scores of teacher's form. After post hoc analysis, the scores of parents' ratings of Anxious and Not Depressed group and Anxious and Depressed group were higher than those of the Normal group. CONCLUSION: The mothers who are depressed and/or anxious tend to report more behavior problems of children than now they actually are.

Therapeutic Effects of Psychosocial Programs in the Day Care Service on Cognitive Impairment and Depressive Symptoms in the Elderly Patients / 신경정신의학

Cognitive impairment and depression are the most common symptoms affecting the elderly on physical and mental states. Studies have shown that these symptoms in mild cases are improved by psychosocial intervention, emphasizing the importance of therapeutic intervention provided in the community. The purpose of this study was to investigate whether the psychosocial program at a geriatric day care service has any therapeutic effect on the cognitive function and depressive symptoms in the elderly and whether such effect can be maintained. The experimental group was composed of 37 elderly patients attending the day care service at the mental health center located in Kwangju county, Kyonggi province. The control group was composed of 22 elderly patients who either refused intervention or who dropped out of the program. Cognitive function was assessed with the Korean version of the Mini-Mental State Exam(MMSE-K) and depressive symptoms were assessed with the Short-form Geriatric Depression Scale(SGDS) The experimental group and the control group were compared on the score of on each test, which was administered before and after the program and 10 weeks after discontinuation of program. In the experimental group, the scores acquired immediately after the program and at 10 weeks of follow-up were also compared. The results showed that psychosocial intervention at a geriatric day care service was significantly associated with the change in SGDS scores dependent on time but not significantly associated with the change in MMSE-K scores. In the experimental group whose follow-up assessment was possible, it was further shown that 43% of patients had increased SGDS scores 10 weeks after the program ended, indicating that depressive symptoms had worsened. This study suggests that psychosocial therapeutic intervention in the geriatric day care service improve depressive symptoms but not cognitive functions in the elderly. In addition, for a considerable percentage of subjects in the experimental group, the improvements in depressive symptoms were not sustained after the intervention was withdrawn. These findings proposes a need of strengthening therapeutic intervention to maintain such effect.