Alteration in Cngb1 Expression upon Maternal Immune Activation in a Mouse Model and Its Possible Association with Schizophrenia Susceptibility

Objective@#The cyclic nucleotide-gated channel (Cng) regulates synaptic efficacy in brain neurons by modulating Ca2＋ levels in response to changes in cyclic nucleotide concentrations. This study investigated whether the expression of Cng channel, cyclic nucleotide-gated channel subunit beta 1 (Cngb1) exhibited any relationship with the pathophysiology of schizophrenia in an animal model and whether genetic polymorphisms of the human gene were associated with the progression of schizophrenia in a Korean population. @*Methods@#We investigated whether Cngb1 expression was related to psychiatric disorders in a mouse model of schizophrenia induced by maternal immune activation. A case-control study was conducted of 275 schizophrenia patients and 410 controls with single-nucleotide polymorphisms (SNPs) in the 5′-near region of CNGB1. @*Results@#Cngb1 expression was decreased in the prefrontal cortex in the mouse model. Furthermore, the genotype frequency of a SNP (rs3756314) of CNGB1 was associated with the risk of schizophrenia. @*Conclusion@#Our results suggest that CNGB1 might be associated with schizophrenia susceptibility and maternal immune activation. Consequently, it is hypothesized that CNGB1 may be involved in the pathophysiology of schizophrenia.

Death by Nitrite Intoxication: Report of 14 Cases / 대한법의학회지

Sodium nitrite intoxication is a primary cause of severe methemoglobinemia, which may be fatal. In the past, nitrite-related deaths were rare, but cases of suicide with nitrite have been increasing in number in recent years. We analyzed 14 cases of fatal nitrite intoxication from January 2013 to February 2019. There was a different trend between the cases from the past and those from recent years. The former consisted of older individuals who ingested nitrite accidentally or intentionally, while the latter comprised younger individuals who used nitrite mostly for suicide. Most individuals showed dark purple or dark brown lividity and cherry-pink discoloration of the muscles. Postmortem methemoglobin levels, which were analyzed in 5 cases, were 30%-49%. Most nitrite and nitrate concentrations showed the highest concentration in the stomach contents, and it showed that the nitrite was converted into nitrate in the blood. To conclude, methemoglobin tests using a portable oximeter and quantitative tests of nitrite and nitrate, as well as a thorough investigation of the case and scene may help determine the cause of death.

Effect of Depression on Pulmonary Symptoms and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease / 신경정신의학

OBJECTIVES@#Depression is a common comorbid condition in patients with chronic obstructive pulmonary disease (COPD) and has a higher prevalence than the general population. On the other hand, studies on the incidence of depression and quality of life in COPD patients often depend on a simple self-report questionnaire rather than a psychiatrist's clinical assessment. Starting with accurately diagnosing depression, the purpose of this study was to evaluate the factors related to depression as well as how depression influences the quality of life.@*METHODS@#The study included 30 patients diagnosed with COPD. All the patients were interviewed for a diagnosis of depression by a psychiatrist. They were divided into two groups: with and without depression. For dyspnea, the modified Medical Research Council (mMRC) scale was used to evaluate how it affected daily life. Short-Form Health Survey 36 and COPD assessment test (CAT) were used to assess the quality of life.@*RESULTS@#The degree of COPD and respiratory symptoms were related, but the severity of COPD did not influence the quality of life. In the presence of depression, mMRC and CAT were higher, whereas PCS and MCS were lower than in those without depression. Patients with depression suffered more from dyspnea and had a lower quality of life.@*CONCLUSION@#This study suggests that the degree of COPD was not related to depression. With depression, however, it led to the aggravation of dyspnea and a deteriorated quality of life. Combined treatment is essential to improving the patients' general well-being.

Worker Safety in the Rare Earth Elements Recycling Process From the Review of Toxicity and Issues

Although the rare earth elements (REEs) recycling industry is expected to increase worldwide in high-tech industry, regulations for worker safety have yet to be established. This study was conducted to understand the potential hazard/risk of REE recycling and to support the establishment of regulations or standards. We review the extensive literature on the toxicology, occupational safety, and health issues, and epidemiological surveys related to the REEs, and propose suitable management measures. REE recycling has four key steps such as collection, dismantling, separation, and processing. In these processes, hazardous substances, such as REEs-containing dust, metals, and chemicals, were used or occurred, including the risk of ignition and explosion, and the workers can be easily exposed to them. In addition, skin irritation and toxicities for respiratory, nervous, and cardiovascular systems with the liver toxicity were reported; however, more supplementary data are needed, owing to incompleteness. Therefore, monitoring systems concerning health, environmental impacts, and safety need to be established, based on additional research studies. It is also necessary to develop innovative and environment-friendly recycling technologies, analytical methods, and biomarkers with government support. Through these efforts, the occupational safety and health status will be improved, along with the establishment of advanced REE recycling industry.

Reliability and Validity of the Brief Schema Questionnaire for Adult / 신경정신의학

OBJECTIVES: The aim of this study was to develop a brief schema questionnaire for adults (BSQ-A) and investigate its validity and reliability. METHODS: A 36-item questionnaire was developed or selected by six psychiatrists. The questionnaire was administered to 209 subjects in Seoul and Gyeonggi area. The construct validity was investigated by performing principal component analysis, and the reliability was assessed in terms of the internal consistency using Cronbach's alpha. RESULTS: The principal component analysis revealed 18 factors underlying 18 early maladaptive schemas (EMSs). These 18 factors accounted for 87.488% of the common variance. The Cronbach's alpha was high, indicating that the reliability of the questionnaire was satisfactory. Every schema showed a positive correlation with most psychological measures. CONCLUSION: The results indicate that the BSQ-A is a reliable and valid scale for assessing EMSs. Although there are many limitations, the present study is expected to form the basis of future research.

Reliability and Validity of the Mental Health Questionnaire for Adult / 신경정신의학

OBJECTIVES: The aim of this study was to develop a Mental Health Questionnaire for Adults (MHQ-A) and investigate its validity and reliability. METHODS: A 73-item questionnaire was developed or selected by seven psychiatrists and a clinical psychologist. The questionnaire was administered to 351 subjects in Seoul and Gyeonggi area. The construct validity was investigated by performing principal component analysis, and the reliability was assessed in terms of the internal consistency using Cronbach's alpha. RESULTS: Principal component analysis revealed 15 factors underlying the psychiatric disorder and symptom category. Taken together, these 15 factors accounted for 64.023% of the common variance. Cronbach's alpha was high, indicating that the reliability of the questionnaire was satisfactory. Every category showed a positive correlation with most psychological measures. CONCLUSION: These results indicate that the MHQ-A is a reliable and valid scale for assessing psychiatric disorders. Although there were many limitations, the present study has significance as the basis of future research.

Influence of clozapine on neurodevelopmental protein expression and behavioral patterns in animal model of psychiatric disorder induced by low-level of lead

Exposure to lead during pregnancy is a risk factor for the development of psychiatric disorders in the offspring. In this study, we investigated whether exposure to low levels of lead acetate (0.2%) in drinking water during pregnancy and lactation causes behavioral impairment and affects the expression of proteins associated with neurodevelopment. Lead exposure altered several parameters in rat offspring compared with those unexposed in open-field, social interaction, and pre-pulse inhibition tests. These parameters were restored to normal levels after clozapine treatment. Western blot and immunohistochemical analyses of the hippocampus revealed that several neurodevelopmental proteins were downregulated in lead-exposed rats. The expression was normalized after clozapine treatment (5 mg/kg/day, postnatal day 35–56). These findings demonstrate that downregulation of several proteins in lead-exposed rats affected subsequent behavioral changes. Our results suggest that lead exposure in early life may induce psychiatric disorders and treatment with antipsychotics such as clozapine may reduce their incidence.

Patient Safety Awareness and Emergency Response Ability Perceived by Nursing Homes and Home Visiting Caregivers / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify patient safety awareness and emergency response ability and affecting factors perceived by nursing homes and home visiting caregivers. METHODS: This study was a descriptive study that conveniently extracts nursing caregivers who care for elderly patients in S and G provinces, Korea. Data collection was done by structural questionnaires from April to May 2018. A total of 204 responses consisting of 103 nursing homes and 101 home visiting caregivers were used for data analysis in SPSS Win 22.0. RESULTS: Patient safety awareness and emergency response ability of nursing homes caregivers with each 4.24±0.50, 74.26±09.57 was each higher than that of the home visiting caregivers with 3.68±0.49, 68.02±12.12 (p < .001). The affecting factors of the patient safety awareness were working place, safety education, and daily average working hours with 12 or more (F = 27.30, p < .001) and that of emergency response ability were number of patients per personnel with 9 or more and emergency situation experience (F=14.00, p < .001). CONCLUSION: These results suggest that it is necessary to develop a safety education program that can share indirectly experience emergency situations that occur on the job site.

CT-Guided Percutaneous Transthoracic Needle Biopsy Using the Additional Laser Guidance System by a Pulmonologist with 2 Years of Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy / 결핵및호흡기질환

BACKGROUND: We developed an additional laser guidance system to improve the efficacy and safety of conventional computed tomography (CT)–guided percutaneous transthoracic needle biopsy (PTNB), and we conducted this study to evaluate the efficacy and safety of our system. METHODS: We retrospectively analyzed the medical records of 244 patients who underwent CT-guided PTNB using our additional laser guidance system from July 1, 2015, to January 20, 2016. RESULTS: There were nine false-negative results among the 238 total cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of our system for diagnosing malignancy were 94.4% (152/161), 100% (77/77), 100% (152/152), 89.5% (77/86), and 96.2% (229/238), respectively. The results of univariate analysis showed that the risk factors for a false-negative result were male sex (p=0.029), a final diagnosis of malignancy (p=0.033), a lesion in the lower lobe (p=0.035), shorter distance from the skin to the target lesion (p=0.003), and shorter distance from the pleura to the target lesion (p=0.006). The overall complication rate was 30.5% (74/243). Pneumothorax, hemoptysis, and hemothorax occurred in 21.8% (53/243), 9.1% (22/243), and 1.6% (4/243) of cases, respectively. CONCLUSION: The additional laser guidance system might be a highly economical and efficient method to improve the diagnostic efficacy and safety of conventional CT-guided PTNB even if performed by inexperienced pulmonologists.

Effects of platelet-rich plasma on tooth replantation in dogs: a histologic and histomorphometric analysis

PURPOSE: The purpose of this study was to evaluate the effects of platelet-rich plasma (PRP) on periodontal healing of replanted root surfaces in dogs histologically and histomorphometrically. METHODS: A total of 36 roots of mandibular incisors and premolars from 6 mongrel dogs were used. The roots were randomly divided into 3 groups: 1) a positive control group (n=12), in which the periodontal ligament (PDL) and cementum were retained and the roots were soaked in saline; 2) a negative control group (n=12), in which the PDL and cementum were removed and the roots were soaked in saline; and 3) an experimental group (n=12), in which the PDL and cementum were removed and the roots were soaked in PRP. After soaking the root surfaces, the extracted roots were replanted into the extraction sockets. The roots were covered using a coronally repositioned flap RESULTS: Histologically, irregular-thickness PDL-like and cementum-like tissues were observed in the 4-week experimental group and the positive control group. PDL-like tissue and cementum-like tissue with a more uniform thickness were observed at 8 weeks. In the negative control group, PDL-like tissue and cementum-like tissue were rarely found, and root resorption and ankylosis were observed. In the cross-sectional histomorphometric analysis, the experimental group demonstrated a higher rate of formation of cementum-like tissue and a lower tooth ankylosis rate than the positive and negative control groups at 4 and 8 weeks. Although there was a significant difference in the tooth ankylosis rate and the formation of cementum-like tissue across the 3 groups (P 0.017). CONCLUSIONS: Applying PRP to root surfaces during tooth replantation in dogs can reduce tooth ankylosis and increase PDL-like and cementum-like tissue formation.

Effects of 1,25-dihydroxyvitamin D₃ on the differentiation of MC3T3-E1 osteoblast-like cells

PURPOSE: The purpose of this study was to evaluate the effects of 1,25-dihydroxyvitamin D₃ on the proliferation, differentiation, and matrix mineralization of MC3T3-E1 osteoblast-like cells in vitro. METHODS: MC3T3-E1 osteoblastic cells and 1,25-dihydroxyvitamin D₃ were prepared. Cytotoxic effects and osteogenic differentiation were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, alkaline phosphatase (ALP) activity assay, ALP staining, alizarin red S staining, and reverse transcription-polymerase chain reaction (RT-PCR) for osteogenic differentiation markers such as ALP, collagen type I (Col-I), osteocalcin (OCN), vitamin D receptor (VDR), and glyceraldehyde 3-phosphate dehydrogenase. RESULTS: The MTT assay showed that 1,25-dihydroxyvitamin D₃ did not inhibit cell growth and that the rate of cell proliferation was higher than in the positive control group at all concentrations. ALP activity was also higher than in the positive control group at low concentrations of 1,25-dihydroxyvitamin D₃ (10−10, 10−12, and 10−14 M). RT-PCR showed that the gene expression levels of ALP, Col-I, OCN, and vitamin D receptor (VDR) were higher at a low concentration of 1,25-dihydroxyvitamin D₃ (10−12 M). Alizarin red S staining after treatment with 1,25-dihydroxyvitamin D₃ (10−12 M) showed no significant differences in the overall degree of calcification. In contrast to the positive control group, formation of bone nodules was induced in the early stages of cell differentiation. CONCLUSIONS: We suggest that 1,25-dihydroxyvitamin D₃ positively affects cell differentiation and matrix mineralization. Therefore, it may function as a stimulating factor in osteoblastic bone formation and can be used as an additive in bone regeneration treatment.

Effects of Tianeptine on Adult Rats Following Prenatal Stress

OBJECTIVE: Exposing a pregnant female to stress during the critical period of embryonic fetal brain development increases the risk of psychiatric disorders in the offspring. The objective of this study was to investigate the effect of antidepressant tianeptine on prenatally stressed (PNS) rats. METHODS: In this study, a repeated variable stress paradigm was applied to pregnant rats during the last week of gestation. To investigate the effects of antidepressant tianeptine on PNS rats, behavioral and protein expression analyses were performed. Forced swim test, open field test, and social interaction test were performed to determine changes in PNS rats compared to non-stressed offspring. Haloperidol was used as a positive control as an antipsychotic drug based on previous studies. RESULTS: Behavioral changes were restored after treatment with tianeptine or haloperidol. Western blot and immunohistochemical analyses of the prefrontal cortex revealed downregulation of several neurodevelopmental proteins in PNS rats. After treatment with tianeptine or haloperidol, their expression levels were increased. CONCLUSION: Downregulation of several proteins in PNS rats might have caused subsequent behavioral changes in PNS rats. After tianeptine or haloperidol treatment, behavioral changes in PNS rats were restored. Therefore, tianeptine might decrease incidence of prenatal stress related-psychiatric disorders such as depression and schizophrenia.

Effects of tianeptine on symptoms of fibromyalgia via BDNF signaling in a fibromyalgia animal model

Previous reports have suggested that physical and psychological stresses may trigger fibromyalgia (FM). Stress is an important risk factor in the development of depression and memory impairments. Antidepressants have been used to prevent stress-induced abnormal pain sensation. Among various antidepressants, tianeptine has been reported to be able to prevent neurodegeneration due to chronic stress and reverse decreases in hippocampal volume. To assess the possible effect of tianeptine on FM symptoms, we constructed a FM animal model induced by restraint stress with intermittent cold stress. All mice underwent nociceptive assays using electronic von Frey anesthesiometer and Hargreaves equipment. To assess the relationship between tianeptine and expression levels of brain-derived neurotrophic factor (BDNF), cAMP response element-binding protein (CREB), and phosphorylated cAMP response element-binding protein (p-CREB), western blotting and immunohistochemistry analyses were performed. In behavioral analysis, nociception tests showed that pain threshold was significantly decreased in the FM group compared to that in the control group. Western blot and immunohistochemical analyses of medial prefrontal cortex (mPFC) and hippocampus showed downregulation of BDNF and p-CREB proteins in the FM group compared to the control group. However, tianeptine recovered these changes in behavioral tests and protein level. Therefore, this FM animal model might be useful for investigating mechanisms linking BDNF-CREB pathway and pain. Our results suggest that tianeptine might potentially have therapeutic efficacy for FM.

The association between radiographic embrasure morphology and interdental papilla reconstruction using injectable hyaluronic acid gel

PURPOSE: The purpose of this study was to evaluate the clinical efficacy of enhancing deficient interdental papilla with hyaluronic acid gel injection by assessing the radiographic anatomical factors affecting the reconstruction of the interdental papilla. METHODS: Fifty-seven treated sites from 13 patients (6 males and 7 females) were included. Patients had papillary deficiency in the upper anterior area. Prior to treatment, photographic and periapical radiographic standardization devices were designed for each patient. A 30-gauge needle was used with an injection-assistance device to inject a hyaluronic acid gel to the involved papilla. This treatment was repeated up to 5 times every 3 weeks. Patients were followed up for 6 months after the initial gel application. Clinical photographic measurements of the black triangle area (BTA), height (BTH), and width (BTW) and periapical radiographic measurements of the contact point and the bone crest (CP-BC) and the interproximal distance between roots (IDR) were undertaken using computer software. The interdental papilla reconstruction rate (IPRR) was calculated to determine the percentage change of BTA between the initial and final examination and the association between radiographic factors and the reconstruction of the interdental papilla by means of injectable hyaluronic acid gel were evaluated. RESULTS: All sites showed improvement between treatment examinations. Thirty-six sites had complete interdental papilla reconstruction and 21 sites showed improvement ranging from 19% to 96%. The CP-BC correlated with the IPRR. More specifically, when the CP-BC reached 6 mm, virtually complete interdental papilla reconstruction via injectable hyaluronic acid gel was achieved. CONCLUSIONS: These results suggest that the CP-BC is closely related to the efficacy of hyaluronic acid gel injection for interdental papilla reconstruction.

Clinical and Microbiological Study about Efficacy of Air-polishing and Scaling and Root-planing

The efficacy of air-polishing on subgingival debridement, as compared to scaling and root planning (SRP), was evaluated clinically and microbiologically. Fifteen patients diagnosed as chronic periodontitis, and having single-root tooth over 5 mm of pocket depth symmetrically in the left and right quadrant, were investigated. Subgingival debridement was performed by SRP and air-polishing. The results were evaluated and compared clinically and microbiologically. Probing pocket depth (PPD), bleeding on probing (BOP), relative attachment level (RAL) and change of gingival crevicular fluid (GCF) were assessed before treatment, and at 14 and 60 days after treatment. Microbial analysis was done pre-treatment, post-treatment, and at 14 and 60 days after treatment. Results of air polishing showed that post treatment, the PPD and BOP decreased, and attachment gain was observed. There was no clinical difference when compared to SRP. The volume of GCF decreased at 14 days, and increased again at 60 days. Compared to SRP, there was a statistical significance of the volume of GCF at 60 days in air-polishing. In the microbial analysis, high-risk bacteria that cause periodontal disease were remarkably reduced. They decreased immediately after treatment, but increased again with the passage of time. Thus, our results show that subgingival debridement by air-polishing was effective for decrease of pocket depth, attachment gain, decrease of GCF and inhibition of pathogens. Further studies are required to compare air-polishing and SRP, considering factors such as degree of pocket depth and calculus existence.

Malignant Mesothelioma Diagnosed by Bronchoscopic Biopsy / 결핵및호흡기질환

Malignant mesothelioma is a rare malignant neoplasm that arises from mesothelial surfaces of the pleural cavity, peritoneal cavity, tunica vaginalis, or pericardium. Typically, pleural fluid cytology or closed pleural biopsy, surgical intervention (video thoracoscopic biopsy or open thoracotomy) is conducted to obtain pleural tissue specimens. However, endobronchial lesions are rarely seen and cases diagnosed from bronchoscopic biopsy are also rarely reported. We reported the case of a 77-year-old male who was diagnosed as malignant mesothelioma on bronchoscopic biopsy from obstructing masses of the endobronchial lesion.

Ethics in the Intensive Care Unit / 결핵및호흡기질환

The intensive care unit (ICU) is the most common place to die. Also, ethical conflicts among stakeholders occur frequently in the ICU. Thus, ICU clinicians should be competent in all aspects for ethical decision-making. Major sources of conflicts are behavioral issues, such as verbal abuse or poor communication between physicians and nurses, and end-of-life care issues including a lack of respect for the patient's autonomy. The ethical conflicts are significantly associated with the job strain and burn-out syndrome of healthcare workers, and consequently, may threaten the quality of care. To improve the quality of care, handling ethical conflicts properly is emerging as a vital and more comprehensive area. The ICU physicians themselves need to be more sensitive to behavioral conflicts and enable shared decision making in end-of-life care. At the same time, the institutions and administrators should develop their processes to find and resolve common ethical problems in their ICUs.

Effect of the education interval and method on improving Patients' plaque control ability / 대한구강보건학회지

OBJECTIVES: This study aimed to evaluate the effect of oral health education interval and toothbrushing instruction, the difference between the demonstration-only method and the demonstration with chairside practice toothbrushing instruction method, and the effect of initial patient plaque control ability on the plaque index. METHODS: Patients (n=60) were randomly assigned to receive a 1-week, 2-week, or 3-week interval of oral health education and toothbrushing instruction. Each group was further subdivided into the demonstration-only group and the demonstration with chairside practice group. Patients were categorized as having "good", "fair", or "poor" initial plaque control ability, based on the Turesky modification of the Quigley-Hein plaque index (TQHI). Patients attended five sessions during which they received oral health education and toothbrushing instruction of the modified Bass technique. Plaque evaluation was performed at each visit using the TQHI. RESULTS: The plaque index tended to improve from the first visit to the fifth visit, but there were no significant differences between the 1-week, 2-week, and 3-week education interval. The demonstration with the chairside practice group showed significantly greater improvements in the plaque index, compared to the demonstration-only group. In the good, fair, and poor plaque control ability groups, the plaque index improved gradually from the first to the fifth visit. When plaque control was poor, the improvement in the plaque index increased to a greater degree after oral health education and toothbrushing instruction. CONCLUSIONS: The results of this study may be helpful for suggesting appropriate individualized oral hygiene management methods to improve plaque control ability.

Pumpless extracorporeal interventional lung assist for bronchiolitis obliterans after allogenic peripheral blood stem cell transplantation for acute lymphocytic leukemia / 영남의대학술지

Bronchiolitis obliterans (BO), which is associated with graft-versus-host disease after allogenic hematopoietic stem cell transplantation, is a major obstacle to survival after bone marrow transplantation due to its gradual progress, eventually leading to respiratory failure. Pumpless extracorporeal interventional lung assist (iLA) is effective in treatment of reversible hypercapnic respiratory failure. In this paper, we present a 23-year-old female patient who underwent allogeneic peripheral blood stem cell transplantation (PBSCT) for acute lymphocytic leukemia. After 6 months, she complained of shortness of breath and was diagnosed with BO. Five months later, she developed an upper respiratory tract infection that worsened her BO and caused life-threatening hypercapnia. Since mechanical ventilation failed to eliminate CO2 effectively, iLA was applied as rescue therapy. Her hypercapnia and respiratory acidosis showed significant improvement within a few hours, and she was successfully weaned off iLA after 12 days. This is the first case report of iLA application for temporarily aggravated hypercapnia of PBSCT-associated BO followed by successful weaning. This rescue therapy should be considered in ventilator-refractory reversible hypercapnia in BO patients.

A Case of Eosinophilic Pleural Effusion Caused by Toxocariasis without Serum Eosinophilia

Human toxocariasis is a parasitic disease caused by Toxocara canis or Toxocara cati. We report a patient with toxocariasis who presented with dyspnea and left pleural effusion. All patients with toxocariasis in published case reports had serum eosinophilia. This is the first case report of eosinophilic pleural effusion without serum eosinophilia caused by toxocariasis infection, which was confirmed by using enzyme-linked immunosorbent assay (ELISA). Therefore, an antibody ELISA can be useful for diagnosing toxocariasis in patients with a pleural effusion of unknown cause, even in the absence of serum eosinophilia.