Effects of circadian blood pressure patterns on development of microvascular complications in pediatric patients with type 1 diabetes mellitus

Purpose@#The effects of circadian blood pressure (BP) alterations on the development and progression of microvascular complications in type 1 diabetes mellitus (T1DM) patients are unknown. We evaluated the effects of circadian BP alterations with development of microvascular complications during follow-up with patients with childhood-onset T1DM. @*Methods@#We investigated the medical records of 81 pediatric patients with T1DM who underwent 24-hour ambulatory BP monitoring (ABPM) between January 2009 and February 2010. @*Results@#Mean age at diagnosis and ABPM evaluation was 8.0±3.9 and 15.6±2.4 years, respectively. Hypertension (daytime, nighttime, and 24-hour mean hypertension) data were available in 42 patients. During the 8 years of follow-up after ABPM, microvascular complications occurred in 8 patients (diabetic retinopathy [DR] alone in 5, microalbuminuria alone in 2, and both in 1), of whom 7 had nondipper BP. Nighttime diastolic BP, nighttime mean arterial pressure, and glycated hemoglobin A (HbA1c) level were higher in patients with DR than in those without DR (P<0.05 for all). Daytime or nighttime BP and presence of dipper BP were not related to microvascular complications, but diabetic microvascular complications were more likely to occur in patients with an older age at diagnosis and higher HbA1c level. The proportion of patients with DR was higher in those with nondipper hypertension (83.3%) compared with dipper and nondipper normotension (0% and 16.7%, respectively; P=0.021). @*Conclusion@#As a predictor of microvascular complications, nondipper hypertension was not significant. Glycemic control rather than nondipper hypertension is the predominant factor determining DR in T1DM patients.

Hyperammonemic Encephalopathy Mimicking Ornithine Transcarbamylase Deficiency in Fibrolamellar Hepatocellular Carcinoma: Successful Treatment with Continuous Venovenous Hemofiltration and Ammonia Scavengers / Journal of the Korean Cancer Association, 대한암학회지

Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare liver cancer affecting adolescents and young adults without any pre existing liver disease. Hyperammonemic encephalopathy (HAE) is a serious paraneoplastic syndrome, and several cases of HAE have been reported in patients with FLHCC. This condition is rare; hence, there are currently no management guidelines for cancer-related HAE. Herein, we report a case of an 18-year-old man with advanced FLHCC who developed HAE during the first course of chemotherapy consisting of cisplatin, doxorubicin, 5-fluorouracil, and interferon-α. He was successfully treated with continuous venovenous hemofiltration, sodium benzoate, sodium phenylbutyrate, and amino acid supplementation for HAE. After the second course of chemotherapy, he underwent surgery, and thereafter, his ammonia levels were normal without any ammonia scavenger therapy. Treatments for HAE described here will be helpful for this rare, but serious metabolic complication of FLHCC and could partially applied to HAE related to any malignancies.

Antineutrophil Cytoplasmic Antibodies Negative Microscopic Polyangiitis With Initial Pulmonary Manifestation

Microscopic polyangiitis (MPA) is a small vessel vasculitides mostly associated with anti-neutrophil cytoplasmic antibodies (ANCA). The kidney is the most commonly affected organ in MPA. We report the case of a 9-year-old girl with ANCA-negative MPA who initially presented with respiratory symptoms, including cough, sputum, and dyspnea. Based on her symptoms, atypical pneumonia was suspected. Also, childhood interstitial lung disease was considered based on findings seen on chest CT. Despite initial improvement of symptoms with oral corticosteroid therapy, dyspnea with initiation of corticosteroid tapering was noted. A final diagnosis of MPA was made after lung biopsy. ANCA was negative in both the initial and repeat blood tests. Oral cyclophosphamide and prednisolone treatments led to full remission. Since then, the patient has been treated with low dose prednisolone and azathioprine for maintenance. A good treatment response was achieved and her clinical symptoms, pulmonary functions, and radiologic findings have since improved. Thus, early and precise diagnosis of MPA is crucial for remission induction and prevention of symptom relapse.

Impact of Emotional Intelligence and Vocational Calling on Post-traumatic Growth in Police Officers / 정신간호학회지

PURPOSE: Post-traumatic growth in police officers is important. This study was performed to determine the impact of emotional intelligence and vocational calling on post-traumatic growth. METHODS: For this descriptive correlation study, participants were 184 police officers, working in one of eleven police stations. Data were collected from February 15 to February 28, 2017 using self-report questionnaires. Analysis was done using t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression with IBM SPSS 19.0. RESULTS: Emotional intelligence and vocational calling were positively correlated with post traumatic growth. Analysis of the impact of emotional intelligence and vocational calling on post-traumatic growth showed that emotional intelligence was the most significant predictor variable. Moreover, there was a mediating effect of vocational calling in the relationship between emotional intelligence and post-traumatic growth. CONCLUSION: The study results suggest that improvement in police officer's emotional intelligence and vocational calling increases their post-traumatic growth. It is necessary to device strategies which strengthen emotional intelligence and vocational calling in order to improve the post-traumatic growth of police officers.

A Personalized and Learning Approach for Identifying Drugs with Adverse Events

PURPOSE: Adverse drug events (ADEs) are associated with high health and financial costs and have increased as more elderly patients treated with multiple medications emerge in an aging society. It has thus become challenging for physicians to identify drugs causing adverse events. This study proposes a novel approach that can improve clinical decision making with recommendations on ADE causative drugs based on patient information, drug information, and previous ADE cases. MATERIALS AND METHODS: We introduce a personalized and learning approach for detecting drugs with a specific adverse event, where recommendations tailored to each patient are generated using data mining techniques. Recommendations could be improved by learning the associations of patients and ADEs as more ADE cases are accumulated through iterations. After consulting the system-generated recommendations, a physician can alter prescriptions accordingly and report feedback, enabling the system to evolve with actual causal relationships. RESULTS: A prototype system is developed using ADE cases reported over 1.5 years and recommendations obtained from decision tree analysis are validated by physicians. Two representative cases demonstrate that the personalized recommendations could contribute to more prompt and accurate responses to ADEs. CONCLUSION: The current system where the information of individual drugs exists but is not organized in such a way that facilitates the extraction of relevant information together can be complemented with the proposed approach to enhance the treatment of patients with ADEs. Our illustrative results show the promise of the proposed system and further studies are expected to validate its performance with quantitative measures.

Morphological characteristics of the upper airway and pressure drop analysis using 3D CFD in OSA patients / 대한치과교정학회지

OBJECTIVE: Obstructive sleep apnea (OSA) is a common disorder which is characterized by a recurrence of entire or partial collapse of the pharyngeal airway during sleep. A given tidal volume must traverse the soft tissue tube structure of the upper airway, so the tendency for airway obstruction is influenced by the geometries of the duct and characteristics of the airflow in respect to fluid dynamics. METHODS: Individualized 3D FEA models were reconstructed from pretreatment computerized tomogram images of three patients with obstructive sleep apnea. 3D computational fluid dynamics analysis was used to observe the effect of airway geometry on the flow velocity, negative pressure and pressure drop in the upper airway at an inspiration flow rate of 170, 200, and 230 ml/s per nostril. RESULTS: In all 3 models, large airflow velocity and negative pressure were observed around the section of minimum area (SMA), the region which narrows around the velopharynx and oropharynx. The bigger the Out-A (outlet area)/ SMA-A (SMA area) ratio, the greater was the change in airflow velocity and negative pressure. CONCLUSIONS: Pressure drop meaning the difference between highest pressure at nostril and lowest pressure at SMA, is a good indicator for upper airway resistance which increased more as the airflow volume was increased.

Totally Laparoscopic Total Gastrectomy for Early Gastric Cancer: An Initial Experience

PURPOSE: We wanted to evaluate the technical feasibility and safety of totally laparoscopic total gastrectomy (TLTG) for treating early gastric cancer. MATERIALS AND METHODS: The medical records of 11 consecutive patients who underwent TLTG after being diagnosed with early gastric cancer at Incheon St. Mary's Hospital, The Catholic University of Korea from February 2005 to September 2009 were retrospectively reviewed and their clinicopathologic characteristics and the surgical results were investigated. RESULTS: The mean operation time was 385.6+/-94.1 minutes, the mean time for creating an intracorporeal anastomosis was 97.5+/-60.0 minutes and the mean number of the harvested lymph nodes was 46.6+/-15.4. The mean number of days after operation until starting a liquid diet was the 6.15+/-7.6th postoperative day and the mean hospital stay after surgery was 14.2+/-11.9 days. There was no case of open conversion, but there were 2 cases of intraoperative complication and 3 cases of postoperative complication. There was one case of postoperative mortality. The patient suffered from thrombocytopenia of an unknown cause, which was refractory to platelet transfusion, on 4th postoperative day and the patient died of intraabdominal bleeding on the 6th postoperative day. CONCLUSION: TLTG was a technically feasible and relatively safe procedure. However, a long time for creating the intracoproeal anastomosis and a long operation time are still problems to be solved.

Postcircumcision Color Change of the Glans Penis Associated with a 0.2% Lidocaine Dorsal Nerve Block / 대한남성과학회지

We describe a case of temporary ischemic change of the glans penis after circumcision. A 36-year-old male exhibited an ischemic change in the color of the glans penis the day after receiving a dorsal penile nerve block for circumcision. After the third day, the color of the glans changed from black to dark brown. After 7 days, the glans returned to near normal skin color without other sequelae.

Epidermal Hyperplasia and Elevated HB-EGF are More Prominent in Retinoid Dermatitis Compared with Irritant Contact Dermatitis Induced by Benzalkonium Chloride

BACKGROUND: 'Retinoid dermatitis' is a retinoid-induced irritant contact dermatitis (ICD). The mechanism of retinoid dermatitis may be different from that of other ICDs. However, it remains uncertain how topical retinoid induce ICD. OBJECTIVE: We compared several aspects of contact dermatitis induced by topical retinol and benzalkonium chloride (BKC) on hairless mice skin. METHODS: 2% retinol or 2.5% BKC was applied to hairless mice and transepidermal water loss (TEWL), ear thickness, histologic and immunohistochemical findings were compared. We also compared mRNA expression of inflammatory cytokines, epidermal differential markers, cyclooxygenases (COXs) and heparin binding epidermal growth factor like growth factor (HB-EGF). RESULTS: Topical application of 2% retinol and 2.5% BKC increased TEWL and ear thickness in similar intensity. Epidermal hyperplasia was more prominent in retinol treated skin. Proliferating cell nuclear antigen, involucrin and loricrin expression were higher in retinol-treated skin than in BKC-treated skin. Filaggrin, however, was more expressed in BKC-treated skin. The mRNA expression of IL-8, TNF-alpha, COX-2, involucrin, loricrin and filaggrin were increased in both retinol- and BKC-treated skin in similar intensity. HB-EGF was more significantly increased in retinol-treated skin. CONCLUSION: Elevated HB-EGF and epidermal hyperplasia are more prominent features of retinoid dermatitis than in BKC-induced ICD.

The color stability of aesthetic restorative materials resulting from accelerated aging / 대한치과보철학회지

STATEMENT OF PROBLEM: The discoloration of anterior teeth restoration is one of the material problems demanding retreatment. OBJECTIVES: To evaluate the color stability and affecting factors on esthetic restorative materials when subjected to accelerated aging. MATERIAL AND METHODS: This study was conducted using porcelain disks (IPS Empress 2-glazed, IPS Empress 2-polished), direct restorative resin disks (SYNERGY Duo) and indirect restorative resin disks (Sinfony, TESCERA ATL). Accelerated aging was done by precipitating the specimens in 38 degrees C distilled water and irradiating with xenon light, and the total irradiation was 397.98 KJ/mm. Color and microhardness change of the specimens were measured before accelerated aging and after 100 hours, 200 hours and 300 hours of accelerated aging, and Surface of the specimens were examined with SEM before and after 300 hours of accelerated aging. RESULTS: 1. After 300 hours' accelerated aging, a delta E value was 3.3 or lower in IPS Empress 2-glazed, IPS Empress 2-polished and Sinfony. 2. After 300 hours' accelerated aging, gloss was lost and surface changes including microcracks were observed in TESCERA ATL and SYNERGY Duo, and color changes of them ranged between 3.58 and 6.40 delta E units. 3. During 300 hours' accelerated aging, the microhardness of surface was increased by 3.21 - 19.64 percent in all kinds of composites resin. CONCLUSION: After 300 hours' accelerated aging, SEM images IPS Empress 2-glazed, IPS Empress 2-polished and Sinfony showed little morphological change and their color changes were considered to be clinically acceptable. And there was significant correlation between microhardness changes and color changes of composites (P < .05).

Solitary Metastatic Renal Tumor from Breast Cancer / 대한비뇨기과학회지

We report a case of a metastatic renal tumor secondary to breast cancer 9 years postmastectomy. This is the first case report of solitary renal metastasis from breast cancer with no other evidence of metastasis. A 47-year-old woman underwent a modified radical mastectomy and 6 cycles of CEF chemotherapy (Cyclophosphamide, Epirubicin, 5-FU) for cancer of the left breast. She was followed closely, but no recurrence or metastases were detected on either a physical or radiological examination. 9 years later, on a routine follow-up examination for metastatic breast cancer, abdomen ultrasound revealed a solid mass (4cm in diameter) in the upper portion of the right kidney. Computed tomography (CT) was used to further evaluate the solitary renal mass, which had become moderately enhanced. No regional lymph node, visceral or pulmonary metastases were found. A radionuclide bone scan confirmed no bony involvement. A laparoscopic radical nephrectomy was performed for a right renal tumor. The histopathological features were identical to those for cancer of the right breast. The patient was treated with adjuvant combination chemotherapy (docetaxel and adriamycin), and is still alive 9 months after a right radical nephrectomy, with no evidence of recurrence.

What are Doctors' Clinical Opinions Regarding Circumcision? / 대한비뇨기과학회지

PURPOSE: Circumcision is widely practiced in Korea, but the general principles of circumcision are not established. To date, several studies on the public's attitude regarding circumcision have been reported, but there have been few studies on doctor's opinions. This study was designed to evaluate the difference of clinical opinion regarding circumcision between the doctors in South Korea. MATERIALS AND METHODS: A questionnaire was sent to the doctors working in university hospitals and primary clinics. The items of the questionnaire were for and against circumcision, the actual clinical practice of circumcision, the recommendation of circumcision, the reasons for it and the difficulties in practicing circumcision. RESULTS: Of the 1,000 questionnaires we sent out, 725 were returned. Of 233 urologists, 211 (91%) agreed with performing circumcision and of the 420 doctor of other department, 319 (76%) agreed with performing circumcision. A total of 530 doctors (81%) agreed with performing circumcision. Both the urologists and the doctors practicing in other departments selected hygiene as the reason for practicing circumcision, 155 (73%) and 254 (86%), respectively. The responses to the questionnaire revealed corresponding opinions regarding circumcision between the urologists and doctors of other departments. CONCLUSIONS: Most Korean men were found to be circumcised and they were very much satisfied with the results. In other countries, there was a difference in clinical opinions between doctors concerning circumcision; however, Korean doctors revealed a corresponding opinion regarding circumcision.

Prediction of Sildenafil Response according to Intracavernosal Injection Test in Patients with Erectile Dysfunction / 대한남성과학회지

PURPOSE: The aim of our study was to assess whether an intracavernous injection test can predict the effectiveness of sildenafil oral medication in patients with erectile dysfunction (ED). MATERIALS AND METHODS: A total of 80 patients with ED underwent an intracavernous injection test with trimix (papaverine 18.75 mg+phentolamine 0.625 mg+PGE1 6.25microgram/ml) 0.2 ml. Patients were divided into 2 groups according to rigidity formation following trimix injection: group I had no rigidity formation, group II had some rigidity formation. All patients received a starting dose of 50 mg sildenafil. The dose was adjusted to 100 mg based on its efficacy and tolerability. Erectile function was measured before and during the therapy using the International Index of Erectile Function (IIEF) questionnaire. RESULTS: All patients had erection function (EF) domain scores of the IIEF less than 16, denoting moderate to severe ED (group I, 50 patients; group II, 30 patients). The response rates with sildenafil 50 mg were 24% (12/50) in group I and 87% (26/30) in group II. The overall response rates with sildenafil (50 mg or 100 mg) were 68% (34/50) in group I and 93% (28/30) in group II. The change in ED domain score was significantly higher in group II (9.87+/-3.18 to 15.40+/-4.50; p<0.001) compared to group I (7.80+/-2.43 to 9.08+/-3.84). CONCLUSIONS: The erectile response from the intracavernosal injection test was correlated with the sildenafil response rate. This result implies that intracavernosal injection test may predict the erectile response to oral phosphodiesterase type 5 inhibitor.

The Effect of PDE 4 Inhibitor on Urinary Bladder Function in Normal Rats

PURPOSE: PDE 4 inhibitor is known to be a bladder relaxant. In this study, the effects of PDE 4 inhibitor on the urinary bladder function were evaluated in vivo experiment. We postulated that PDE 4 inhibitor of appropriate concentration might be helpful in the treatment of overactive bladder. MATERIALS AND METHODS: Fifteen Spraque-dawley female rats, weighing approximately 250~300 mg, were used for this study and divided into three groups. PDE 4 inhibitor 486,051 was administrated to each rat by different drug concentrations(0.5 mg/kg, 1 mg/kg, 5 mg/kg). Cystometrogram(CMG) was performed before and 20~60 minutes afterV), bladder capacity(BC), maximal bladder voiding contraction pressure(MVP), intercontrac drug application considering first voiding. Cystometric parameters investigated were voided volume(VV), residual volume (RV), bladder capacity(BC), maximal bladder voiding contraction pressure(MVP), intercontraction interval(ICI). Mean blood pressure was monitored in all rats. RESULTS: PDE 4 inhibitor of 0.5 mg/kg increased the intercontraction interval but not the bladder capacity significantly. PDE 4 inhibitor of 5 mg/kg increased the bladder capacity significantly, but did not show the increased intercontraction interval compared to other groups, and showed the greatest increased residual volume among three groups. PDE 4 inhibitor of 1 mg/kg showed the most increased intercontraction interval and the bladder capacity, and the least decreased voided volume and maximal bladder voiding contraction pressure change. CONCLUSION: PDE 4 inhibitor of different concentrations affects cystometric parameters variably by bladder smooth muscle relaxant. PDE 4 inhibitor of appropriate concentration may be helpful in the treatment of overactive bladder. PDE 4 inhibitor, at the concentration of 1 mg/kg, increased the bladder capacity and intercontraction interval most significantly. This study may provide an important basic data in the future when drug effects were assessed in variable animal models of overactive bladder, etc. However, main limitations of drug use are the increase of residual urine and the decrease of blood pressure. Therefore more bladder specific drug is needed.

Primary Periurethral Malignant Melanoma / 대한비뇨기과학회지

A primary genitourinary melanoma is rare, accounting for less than 1% of all cases of melanoma. They have been presented in case reports, with a subsequent paucity of insight into the natural history of the disease and appropriate management of patients. The prognosis of patients with a genitourinary melanoma is poor. Delay in seeking medical attention for symptoms, and misdiagnosis at presentation, contribute to a more advanced stage at diagnosis. Our case involved a 71 year old woman, who came to our hospital due to vaginal spotting. On local excision, mass was found on the vestibule and forward to the urethra. The pathological diagnosis, by special immunohistochemical staining, such as S-100 protein and HMB-45, was that of a malignant melanoma.