Antioxidant and hepatoprotective effects of Korean ginseng extract GS-KG9 in a D-galactosamine-induced liver damage animal model

BACKGROUND/OBJECTIVES@#This study was designed to investigate the improvement effect of white ginseng extract (GS-KG9) on D-galactosamine (Ga1N)-induced oxidative stress and liver injury. @*SUBJECTS/METHODS@#Sixty Sprague-Dawley rats were divided into 6 groups. Rats were orally administrated with GS-KG9 (300, 500, or 700 mg/kg) or silymarin (25 mg/kg) for 2 weeks. The rats of the GS-KG9- and silymarin-treated groups and a control group were then intraperitoneally injected Ga1N at a concentration of 650 mg/kg for 4 days. To investigate the protective effect of GS-KG9 against GalN-induced liver injury, blood liver function indicators, anti-oxidative stress indicators, and histopathological features were analyzed. @*RESULTS@#Serum biochemical analysis indicated that GS-KG9 ameliorated the elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) in GalN-treated rats. The hepatoprotective effects of GS-KG9 involved enhancing components of the hepatic antioxidant defense system, including glutathione, glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT). In addition, GS-KG9 treatment inhibited reactive oxygen species (ROS) production induced by GalN treatment in hepatocytes and significantly increased the expression levels of nuclear factor erythroid-2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) proteins, which are antioxidant proteins. In particular, by histological analyses bases on hematoxylin and eosin, Masson's trichrome, α-smooth muscle actin, and transforming growth factor-β1 staining, we determined that the administration of 500 mg/kg GS-KG9 inhibited hepatic inflammation and fibrosis due to the excessive accumulation of collagen. @*CONCLUSIONS@#These findings demonstrate that GS-KG9 improves GalN-induced liver inflammation, necrosis, and fibrosis by attenuating oxidative stress. Therefore, GS-KG9 may be considered a useful candidate in the development of a natural preventive agent against liver injury.

Coexistence of Central Diabetes Insipidus andProlonged Cerebral Salt Wasting Syndrome after BrainTumor Surgery: A Case Report

Disturbances in water and salt balances are relatively common in children afterbrain tumor surgery. However, the coexistence of different diseases of water andsodium homeostasis is challenging to diagnose and treat. The coexistence ofcombined central diabetes insipidus (CDI) and cerebral salt wasting syndrome(CSWS) is rare and may impede accurate diagnosis. Herein, we report the case ofan 18-year-old girl who underwent surgery for a germinoma and who presentedprolonged coexistence of CDI and CSWS. The patient was diagnosed with panhypopituitarismwith CDI at presentation and was treated with hydrocortisone, levothyroxine,and desmopressin. Postoperatively, she developed polyuria of morethan 3L/day, with a maximum daily urine output of 7.2 L/day. Her serum sodiumlevel decreased from 148 to 131 mEq/L. Polyuria was treated with desmopressin atincremental doses, and hyponatremia was managed with fluid replacement. At 2months after surgery, she presented with hyponatremia-induced seizure. Polyuriaand hyponatremia combined with natriuresis indicated CSWS. Treatment with fludrocortisonewere initiated; then, her electrolyte level gradually normalized. CSWSis self-limiting and generally resolves within 2 weeks. However, the patient in thisstudy still required treatment with vasopressin and fludrocortisone at 16-monthsafter surgery.Hyponatremia in a patient with CDI may be erroneously interpretedas inadequateCDI control or syndrome of inappropriate antidiuretic hormonesecretion, leading to inappropriate treatment. The identification of the potentialcombination of CDI and CSWS is important for early diagnosis and treatment.

Association of High-Risk Drinking with Metabolic Syndrome and Its Components in Elderly Korean Men: The Korean National Health and Nutrition Examination Survey 2010–2012 / 가정의학회지

BACKGROUND: Previous studies have examined the association between alcohol consumption and metabolic syndrome (MetS) in adults, but studies in the elderly are lacking. We examined the relationship between high-risk alcohol consumption and MetS in elderly Korean men using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire from the 2010–2012 Korean National Health and Nutrition Examination Survey. METHODS: Among 25,534 subjects, 2,807 were men >60 years of age; after exclusions, we included 2,088 men in the final analysis. We categorized the study participants into three groups according to AUDIT score: low risk (0–7), intermediate risk (8–14), and high risk (≥15 points). RESULTS: Among the study population, 17.0% of the men were high-risk drinkers, who had the highest mean waist circumference, systolic and diastolic blood pressure (BP), fasting plasma glucose (FPG), and triglyceride (TG) levels. The overall prevalence of MetS was 41.9% in the elderly men, and it was significantly higher in the group with high (48.3%) versus low (31.9%) AUDIT scores. The prevalence of MetS components (elevated BP, high FPG, high TG, and low high-density lipoprotein cholesterol) was associated with a high AUDIT score. The odds ratios (95% confidence interval) of the high-risk group for MetS, elevated BP, and high TG were 1.40 (1.03–1.89), 1.82 (1.28–2.60), and 1.77 (1.30–2.41) after adjustment for confounding variables. CONCLUSION: AUDIT score was correlated with most MetS components in elderly Korean men.

Clinicopathologic evaluation of myofibroblastoma: A study in two hospitals

OBJECTIVE: To report various anatomic locations and clinical characteristics of pathologically proven myofibroblastoma in Koran patients. METHODS: Pathologic reports of patients who underwent surgeries at two centers between April 2003 and March 2016 were retrieved from the electronic medical record system of the hospital. Pathologic reports were included after performing a search using the keyword “myofibroblastoma”. RESULTS: The cohort consisted of 11 subjects and included eight female and three male individuals. The patients' ages ranged from 9 to 66 years. Tumors were located in the vagina in three patients and presented in the breast in seven patients. One case presented with an abdominal mass. The tumors ranged in mean size from 4.0 to 53.0 mm. Despite a relatively long-term follow-up, no case had evidence of tumor recurrence. CONCLUSION: We evaluated the various anatomic locations of pathologically proven myofibroblastoma in Korean patients. As an extremely rare tumor, physicians should pay special attention to differential diagnosis. Surgical resection is the preferred method for a cure, and the recurrence rate is extremely low.

Granular cell tumor of the esophagus in an adolescent / 소아과

Esophageal granular cell tumor (GCT) is a rare neoplasm originating from the Schwann cells of the submucosal neuronal plexus. Histology is the gold standard for its diagnosis. Endoscopic resection or surgical excision should be considered, depending on the potential for malignancy. Here, we report a case of an esophageal GCT in an adolescent. A 12-year-old boy presented with a 1-year history of dysphagia and vomiting. Upper gastrointestinal endoscopic examination and esophagography showed narrowing of the midesophagus, and computed tomography angiography of the thoracic aorta revealed an esophageal or periesophageal mass posterior to the paratracheal segment of the esophagus. The tumor was surgically excised, and based on the pathological findings, esophageal GCT was diagnosed.

Heterotopic pregnancy after a single embryo transfer

Heterotopic pregnancy is a rare and life-threatening condition which is defined as coexistent intrauterine and ectopic gestation. The risk of ectopic and heterotopic pregnancy is increasing due to the increased risk of multiple pregnancies with the aid of assisted reproductive technologies. However, it hardly happens in the setting of single embryo transfer, since single embryo transfer significantly reduces the incidence of multiple pregnancies. Surprisingly, we experienced a case of heterotopic pregnancy after a single embryo transfer caused by coincidental natural pregnancy during assisted reproductive technologies. An infertile woman who underwent, during her natural cycle, transfer of a single embryo that had been cryopreserved for 3 years was found to be heterotopically pregnant. After an early and successful management with laparoscopic right salpingectomy, she finally reached at full-term vaginal delivery.

Mental Health Problems in Child and Adolescent Obesity

OBJECTIVES: The purpose of this study was to investigate mental health problems in obese child and adolescent patients. We assess the frequency of mental health problems and their differences according to sex, school grade and severity of obesity. METHODS: The sample consisted of 106 children and adolescents aged 8-16 years (61 boys with mean age 10.98±2.26, 45 girls with mean age 9.74±1.96, p=.004) who were diagnosed with obesity and recruited at the Department of Pediatrics of Jeju National University Hospital. The participants completed the Korean-Child Behavior Checklist (K-CBCL), Children's Depression Inventory (CDI), Korean version of the Eating Attitude Test-26 (KEAT-26), and somatotype drawings. RESULTS: The percentage of participants having a T-score in clinical range on one or more CBCL subscale was 37.7%. The percentage of participants in the high risk group for depression (CDI score above 17) was 20.8% and that in the high risk group for eating disorder (EAT-26 score above 20) was 6%. The girls showed significantly lower CBCL T-scores in social competence (48.39±15.66 vs. 38.91±22.04, p=.011), adjustment function (49.51±17.35 vs. 40.38±22.58, p=.020) and school competence (53.34±10.47 vs. 48.22±15.11, p=.042) than the boys, but the percentages of boys and girls in clinical range were not significantly different. The middle school students showed (significantly) higher CBCL T-scores in somatic symptoms (60.86±9.44 vs. 55.74±6.76, p=.005), aggressive behavior (58.81±6.74 vs. 54.68±6.22, p=.009), total problems (59.86±9.91 vs. 54.88±9.76, p=.039) and externalizing problems (57.90±10.57 vs. 52.44±9.38, p=.022) than the elementary school students. The severe obesity group showed significantly higher CBCL T-scores in attention problems (59.18±9.45 vs. 54.15±5.34, p=.001), social problems (59.25±8.59 vs. 55.96±6.50, p=.038), delinquent behavior (58.07±6.97 vs. 54.73±6.00, p=.017) and total problems (59.21±11.65 vs. 54.67±9.03, p=.037) than the mild to moderate obesity group. CONCLUSION: Significant proportions of obese children and adolescents suffer from mental health problems. Clinicians need to pay attention to the mental health risk, especially in obese adolescents and severely obese children and adolescents.

Potentially Inappropriate Medications by Beers Criteria in Older Outpatients: Prevalence and Risk Factors / 가정의학회지

BACKGROUND: Prescription of inappropriate medicine to elderly patients is a major public health care concern. The Beers criteria have been commonly employed as a screening tool to identify the use of potentially inappropriate medications (PIMs). The present study investigated the prevalence of PIM use according to the Beers criteria as well as factors related to PIM use. METHODS: Data obtained from a retrospective survey included 25,810 outpatients aged ≥65 years from a university medical center in Seoul, Korea. PIMs were defined using the Beers criteria. Factors associated with PIM use were evaluated using multiple regression analysis. RESULTS: Of all participants, 7,132 (27.6%) were prescribed at least one PIM. The most commonly prescribed PIMs were alprazolam (11.2%), clonazepam (10.8%), zolpidem (8.7%), quetiapine (8.4%), and hydroxyzine (5.4%). In multivariate logistic regression analysis, having five or more prescription medicines (odds ratio [OR], 11.32; 95% confidence interval [CI], 9.38 to 13.66) and five or more prescribing doctors (OR, 4.40; 95% CI, 3.59 to 5.39) were strongly associated with PIM. In a likelihood ratio test for trend, an increasing number of medications and prescribing doctors were both significantly associated with PIM. CONCLUSION: At a university medical center, the number of medications and the number of prescribing doctors was associated with PIM in older outpatients.

Potentially Inappropriate Medications by Beers Criteria in Older Outpatients: Prevalence and Risk Factors / 가정의학회지

BACKGROUND: Prescription of inappropriate medicine to elderly patients is a major public health care concern. The Beers criteria have been commonly employed as a screening tool to identify the use of potentially inappropriate medications (PIMs). The present study investigated the prevalence of PIM use according to the Beers criteria as well as factors related to PIM use. METHODS: Data obtained from a retrospective survey included 25,810 outpatients aged ≥65 years from a university medical center in Seoul, Korea. PIMs were defined using the Beers criteria. Factors associated with PIM use were evaluated using multiple regression analysis. RESULTS: Of all participants, 7,132 (27.6%) were prescribed at least one PIM. The most commonly prescribed PIMs were alprazolam (11.2%), clonazepam (10.8%), zolpidem (8.7%), quetiapine (8.4%), and hydroxyzine (5.4%). In multivariate logistic regression analysis, having five or more prescription medicines (odds ratio [OR], 11.32; 95% confidence interval [CI], 9.38 to 13.66) and five or more prescribing doctors (OR, 4.40; 95% CI, 3.59 to 5.39) were strongly associated with PIM. In a likelihood ratio test for trend, an increasing number of medications and prescribing doctors were both significantly associated with PIM. CONCLUSION: At a university medical center, the number of medications and the number of prescribing doctors was associated with PIM in older outpatients.

Association Between Usual Vitamin K Intake and Anticoagulation in Patients Under Warfarin Therapy

This study aimed to explore the correlation between usual vitamin K intake and response to anticoagulant therapy among patients under warfarin therapy. We conducted a retrospective survey of patients (n = 50) on continuous warfarin therapy. Clinical information and laboratory parameters were sourced from medical records. Anticoagulant effect was evaluated by using the percent time in therapeutic range (TTR) and the coefficient of variation (CV) of International normalized ratio (INR). Dietary vitamin K intake was assessed using a semi-quantitative food frequency questionnaire that has been developed for the purpose of assessing dietary intake of vitamin K. A total of 50 patients aged between 21 and 87 years were included in the study. The mean vitamin K intake was 262.8 +/- 165.2 microg/day. Study subjects were divided into tertiles according to their usual vitamin K intake. The proportion of men was significantly higher in second and third tertile than first tertile (p = 0.028). The mean percent TTR was 38.4 +/- 28.4% and CV of INR was 31.8 +/- 11.8%. Long-term warfarin therapy group (> or = 3 years) had a higher percentage of TTR as compared to the control group ( 0.05). In conclusion, no significant association was observed between usual vitamin K intake and anticoagulant effects. Further studies are required to consider inter-individual variability of vitamin K intake. Development of assessment tools to measure inter-individual variability of vitamin K intake might be helpful.

Left Atrial Volume is a Predictor of Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: Diastolic dysfunction may develop in conjunction with or without systolic dysfunction in patients with acute myocardial infarction (AMI). The present study investigated the association between left arterial (LA) volume and major adverse cardiac events (MACE) in 772 patients with AMI. METHODS: The patients were divided into groups according to LA volume index (LAVI) measured using echocardiography according to the American Society of Echocardiography guidelines: LAVI > or = 40 mL/m2 (Group I: n = 260, 191 males; age, 71.1 +/- 10.8 years) and LAVI < 40 mL/m2 (Group II: n = 512, 432 males; age, 62.8 +/- 12.7 years). The mean observational period was 314.2 +/- 134.6 days. RESULTS: Group I patients were older than those in Group II. Hypertension (56.8% vs. 46.0%, respectively; p = 0.007) and advanced Killip class (42.6% vs. 21.0%, respectively; p < 0.001) were more frequent in Group I than in Group II. MACE was more prevalent in Group I than in Group II (20.3% vs. 13.7%, respectively; p = 0.037). MACE-free survival rates were higher in Group II than in Group I during clinical follow-up. The multivariate analysis revealed that high LAVI was an independent predictor of mortality (hazard ratio, 3.002; confidedce interval, 1.051-8.569; p = 0.040). CONCLUSIONS: LA volume is an independent predictor of adverse cardiac events in patients with AMI, and the LAVI is useful for AMI risk stratification.

Comparison of Neonatal and Infant Mortality Rates between Infants Born in South Korea and Those Born in the United States

PURPOSE: The neonatal (NMR) or infant mortality rate (IMR) in South Korea is lower than that in the United States. We aimed to investigate the contributing factors to this difference in mortality rates. METHODS: The study populations consisted of five groups, namely group A, comprising live births in South Korea during 2009-2011 (n=1,383,806), and groups B (live births to Korean parents, n=107,309), C (Caucasian births, n=31,588,183), D (African-origin, n=4,381,664), and E (all live births, n=49,384,187) comprising various US live births during 2000-2011. Maternal characteristics, birth outcomes, and mortality rates in these five groups were compared according to birth weight (BW) and gestational age (GA). RESULTS: Maternal characteristics such as BW distribution and very low and low BW rates among infants in South Korea and those in the United States were quite similar. Both rates were significantly lower among the Korean live births than among Caucasian and African-origin live births in the United States. However, the mortality rates of these small birth weight groups were significantly higher in the Korean infants born in South Korea than in those born in the United States, or in Caucasian and African-origin infants born in the United States. Similar results were noted when analyzed according to gestational age. CONCLUSIONS: The NMR or IMR in South Korea is lower than that in the United States, primarily due to the overwhelming favorable BW and GA distribution, despite the lower BW- and GA-specific survival rates in the live births in South Korea than in the United States.

18F-FDG Positron-Emission Tomography/Computed Tomography Findings of Radiographic Lesions Suggesting Old Healed Tuberculosis

The presence of radiographic lesions suggesting old healed tuberculosis (TB) is one of the strongest risk factors for the subsequent development of active TB. We elucidated the metabolic activity of radiographic lesions suggesting old healed TB using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). This cross-sectional study included 63 participants with radiographic lesions suggesting old healed TB and with available 18F-FDG PET/CT scans. The maximum standardized uptake value (SUVmax) measured in the lesions, the clinical characteristics, results of the tuberculin skin test (TST) and interferon-gamma release assay (IGRA) were analyzed. The SUVmax in old healed TB was 1.5 or higher among nine (14.3%) participants. Age (adjusted odds ratio [aOR], 1.23; 95% CI, 1.03-1.46), history of previous TB (aOR, 60.43; 95% CI, 1.71-2131.65), and extent of the lesions (aOR, 1.34; 95% CI, 1.02-1.75) were associated with higher SUVmax. The positive rates for the TST and IGRA were not different between groups with and without increased FDG uptake. Increased FDG uptake on 18F-FDG PET/CT was observed in a subset of patients with radiographic lesions suggesting old healed TB. Given that the factors associated with increased FDG uptake are known risk factors for TB development, the possibility exists that participants with old healed TB lesions with higher SUV on 18F-FDG PET/CT scans might be at higher risk for active TB.

Impact of outdoor air pollution on the incidence of tuberculosis in the Seoul metropolitan area, South Korea

BACKGROUND/AIMS: Although indoor air pollution is a well-known risk factor for tuberculosis (TB), the possible link between outdoor air pollution and TB development has not been examined fully. We assessed the impact of outdoor air pollution on TB development in the Seoul metropolitan area, South Korea. METHODS: The mean concentrations of ambient particulate matter (PM) with an aerodynamic diameter < or = 10 microm (PM10), O3, CO, NO2, and SO2 levels in Seoul, between January 1, 1997 and December 31, 2006, were determined. Furthermore, their association with the risk of developing TB after adjusting for socioeconomic status, between January 1, 2002 and December 31, 2006, was investigated. RESULTS: Between January 1, 2002 and December 31, 2006, a total of 41,185 TB cases were reported in Seoul. Concentrations of PM10, O3, CO, and NO2 were not associated with TB incidence in males or females. However, the interquartile increase in SO2 concentration was associated with a 7% increment in TB incidence (relative risk [RR], 1.07; 95% credible interval [CrI], 1.03 to 1.12) in males but not in females (RR, 1.02; 95% CrI, 0.98 to 1.07). CONCLUSIONS: Long-term exposure to ambient SO2 increased the risk of TB in males.

CD45 is Essential for Lymphocyte Gating in a T-lymphocyte Subset Assay of Bronchoalveolar Lavage Fluid by Flow Cytometry / 임상검사와정도관리

BACKGROUND: Proper gating is important in flow cytometric assays of lymphocyte subsets. Forward light scatter (FSC)/side light scatter (SSC) gating requires application of a lymphocyte purity correction when lymphocyte purity is less than 95%. We compared 3 different gating methods to establish an accurate gating method appropriate for a T-lymphocyte subset assay of bronchoalveolar lavage (BAL) fluid. METHODS: Leukocyte numbers and subtypes in 31 BAL fluid samples were assessed manually and by using an automatic hematology analyzer. T-lymphocyte subsets (T cells, T helper/inducer cells [Th], and T suppressor/cytotoxic cells [Tc]) were assessed by flow cytometry. We compared 3 methods of lymphocyte gating: CD45/SSC gating (reference method), FSC/SSC gating, and FSC/SSC gating with application of a lymphocyte purity correction. Lymphocyte purity was determined by CD45/CD14 staining of BAL fluid. RESULTS: We observed a significant correlation between lymphocyte percentage and lymphocyte purity (r = 0.453, P = 0.011). T-cell results obtained using the reference method were not correlated with the results of the other 2 gating methods (r = 0.189 each, P = 0.308 for FSC/SSC gating and P = 0.310 for FSC/SSC gating with purity correction). Mean differences between the reference method and FSC/SSC gating (T cells: 14.4%, P = 0.002; Th cells: 7.7%, P = 0.006; Tc cells: 7.1%, P = 0.001) were greater than those between the reference method and FSC/SSC gating with purity correction (T cells: 12.1%, P = 0.004; Th cells: 1.7%, P = 0.608; Tc cells: 0.2%, P = 0.957). CONCLUSIONS: Lymphocyte purity correction after FSC/SSC gating improved the accuracy of Th- and Tc-cell measurements, but not T-cell measurements. CD45 is essential for lymphocyte gating in T-lymphocyte subset assays of BAL fluid.

Relationship between Total Sugar Intake and Obesity Indices in Female Collegians

This study investigated the relationship between total sugar intake and obesity indices in 362 female university students. This study was conducted using an anthropometric checkup and 3-day dietary records. Subjects were categorized according to the total sugar intake as or = 83.8 g (group IV, n = 90). No significant differences in age, weight, height, body mass index (BMI), or the percentage of body fat were observed among the four groups. Based on BMI, 20.2% were overweight, and the percentage of body fat was > 30% in 67.1% of all students sampled. Energy intake in each groups was 1,164.7 kcal, 1,488.6 kcal, 1,590.0 kcal, and 1795.8 kcal, respectively (p < 0.001). Total sugar intake in the groups was 20.5 g, 44.6 g, 68.3 g, and 111.8 g, respectively (p < 0.001). Carbonated beverages were identified as the most significant food source for total sugar intake in female university students. The next major foods were ice cream, milk, coffee, fruit, sugar, cookies, bread, chocolate, corn syrup, rice, onion, maple syrup, pickle, and sweet potato. As intake of total sugar increased, intake of energy also increased significantly. Mean daily intakes of fat and calcium/1,000 kcal were significantly higher in group IV than those in the other groups. Mean daily intakes of vitamin C and vitamin E/1,000 kcal were significantly higher in group III than those in the other groups. The percentage of subjects who consumed nutrients below the estimated average requirement was less in the higher total sugar intake group than that in the lower intake group. The obesity indices (weight, BMI, % body fat) were not associated with total sugar intake in the subjects. We conclude that total sugar intake does not seem to influence obesity indices in female university students.

Positive Tuberculin Skin Test or Interferon-Gamma Release Assay in Patients with Radiographic Lesion Suggesting Old Healed Tuberculosis

Radiographic lesions suggesting old healed tuberculosis (TB) is considered a risk factor for the subsequent development of active TB. The aim of this study was to estimate the positive rates of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) in persons with old healed TB. Participants with lesions suggesting old healed TB on chest images and controls without such lesions were prospectively enrolled between January 1, 2010, and January 31, 2011. TST and the QuantiFERON-TB Gold In-Tube test (QFT-GIT) were performed. In total, 193 participants with old healed TB and 126 controls were recruited. The rates of positive TST and QFT-GIT among patients with old healed TB were 54.6% and 77.7%, respectively. The rates of positive TST and QFT-GIT among patients without old healed TB were 38.9% and 61.9%. Sixteen percent of participants with old healed TB showed negative results by both TST and QFT-GIT. The positive rate of TST waned among participants with old healed TB who were older than 60 yr, whereas QFT-GIT positivity was unaffected by age. The positive rates of TST and IGRA among participants with radiographic lesions suggesting old healed TB was higher than without those lesions. In addition, IGRA may be more accurate than TST for the detection of latent TB infection, especially in populations of individuals older than 60 yr.

Nutritional Intake and Nutritional Status by the Type of Hematopoietic Stem Cell Transplantation

The aim of this study was to investigate the changes of nutritional intake and nutritional status and analyze the association between them during hematopoietic stem cell transplantation. This was a retrospective cross sectional study on 36 patients (9 Autologous transplantation group and 27 Allogeneic transplantation group) undergoing hematopoietic stem cell transplantation at The Catholic University of Korea, Seoul St. Mary's Hospital from May to August 2010. To assess oral intake and parenteral nutrition intake, 24-hour recall method and patient's charts review was performed. Nutritional status was measured with the scored patient-generated subjective global assessment (PG-SGA). The subjects consisted of 6 (66.7%) males and 3 (33.3%) females in the autologous transplantation group (auto), 12 (44.4%) males and 15 (55.6%) females in the allogeneic transplantation group (allo). The mean age was 40.9 +/- 13.6 years (auto) and 37.8 +/- 11.0 years (allo). The average hospitalized period was 25.2 +/- 3.5 days (auto) and 31.6 +/- 6.6 days (allo), which were significant different (p < 0.05). Nutritional intake was lowest at Post+1wk in two groups. In addition, calorie intake by oral diet to recommended intake at Post+2wk was low (20.8% auto and 20.5% allo) but there were no significant differences in change of nutritional intake over time (Admission, Pre-1day, Post+1wk, Post+2wk) between auto group and allo group by repeated measures ANOVA test. The result of nutritional assessment through PG-SGA was significantly different at Pre-1day only (p < 0.01). There was a significant negative correlation between the nutritional status during Post+2wk and the oral calorie/protein intake to recommended amount measured during Post+1wk and Post+2wk (p < 0.01). These results could be used to establish evidence-based nutritional care guidelines for patients during hematopoietic stem cell transplantation.

Effects of Full-Time Integrated Self Upper-Extremity Training Program on Functional Recovery and Length of Stay in Stroke Patients

OBJECTIVE: To investigate the effects of full-time integrated self upper-extremity training program (FISUTP) on functional recovery and length of stay in stroke patients. METHOD: Fifty-nine patients were enrolled and divided into FISUTP and control groups. The FISUTP group (n=29) underwent conventional physical and occupational therapy and FISUTP daily during their hospital stay, whereas control group (n=30) received only daily conventional therapy (physical and occupational therapy). The outcome was measured by Korean version of modified Barthel index (K-MBI), Fugl-Meyer motor assessment (FMA), and length of stay (LOS). RESULTS: FISUTP group showed significantly shorter LOS and higher improvement in functional status changes (K-MBI changes and FMA changes) during hospital day than control group (p<0.05). CONCLUSION: The results showed FISUTP is an effective treatment for the improvement of functional outcome and reduction of hospital stay in stroke patients.

Treatment of Late Onset Ankylosing Spondylitis with TNF Antagonist: A Case Series / 대한류마티스학회지

Ankylosing spondylitis is a disease that shows a young age of onset (less than 40 years old), inflammatory back pain, sacroiliitis and a strong association with HLA-B27. Yet some recently reported cases have presented with a late age of onset (more than 55 years old), atypical clinical presentations and a low response to NSAIDs, and this has also been named late onset spondyloarthropathy (LOSPA). As compared with early onset spondyloarthropathy (EOSPA), the LOSPA patients more frequently suffer with combined peripheral arthritis and inflammatory systemic symptoms and a high ESR and CRP level, but they lack the typical axial symptoms. Yet there have been few reports about late onset ankylosing spondylitis (LOAS). The previous cases of LOSPA and LOAS were managed with NSAIDs, steroids, methotrexate and sulfasalazine, but none were managed with TNF antagonists. LOAS is rare and difficult for management because of the patients' older age and the lack of experiences with this malady, so we report here on the four cases of LOAS that were successfully treated by TNF antagonists.