Effect of age on the prognosis of intrahepatic cholangiocarcinoma

Background/Aims@#Intrahepatic cholangiocarcinoma (iCCA) is a subgroup of cholangiocarcinoma and is the second- most-common primary hepatic tumor. Several predictive and prognostic factors have been analyzed; however, in this study we focused on the influence of age. Our aim was to use real-world results to determine the influence of age in iCCA patients. @*Methods@#A retrospective analysis of patients treated between 2005 and 2016 at Konkuk University Medical Center. In total, 133 patients with iCCA were identified. The mass-forming, periductal-infiltrating, and intraductal-growth types were included; patients with extrahepatic or hilar-type cholangiocarcinoma were excluded. We defined two groups: a younger group, age < 65 years, and an older group, age ≥ 65 years. Statistical analyses using univariate and multivariate Cox regression analyses, including the Kaplan-Meier method, were conducted. @*Results@#In total, 114 patients were enrolled. The two groups differed with regard to treatment options such as surgery with adjuvant chemotherapy or palliative chemotherapy (p = 0.012, p < 0.001). The younger group had significantly longer survival than the older group (p = 0.017). In the younger group, patients who received therapy had longer survival than those who did not (hazard ratio, 3.942; 95% confidence interval, 2.053 to 7.569; p < 0.001). Multivariate analysis indicated that younger age, lower bilirubin, low CA 19-9, and no lymph-node involvement were independent factors for improved survival. @*Conclusions@#Younger patients and those who underwent surgery with adjuvant chemotherapy had longer survival. The younger the patient, the more treatments received, including palliative chemotherapy.

Effectiveness of Reading Disorder Intervention Program-Open Trial / 신경정신의학

Objectives@#This study investigated the effectiveness of the intervention program for elementary school students with reading disorders. @*Methods@#The intervention program focused on phonological awareness, phonics, and decoding training applied individually to 25 children with a reading disorder by the teachers in charge for four months. To measure the efficacy, this study evaluated the word reading accuracy, fluency, and the related cognitive functions, including phonemic awareness, phonics, and rapid automatized naming using the Computerized Comprehensive Learning Test-Reading before and after the program. @*Results@#After the intervention, improvements were observed in the following: the reading fluency score and fluency percentile in the word attack test; reading accuracy rate, fluency score, and fluency percentile in the nonword decoding test; fluency score and fluency percentile in the rapid automatized naming tests; accuracy rate in the letter-sound matching test; accuracy rate in the nonword repetition test. On the other hand, there was no significant difference in the paragraph reading fluency test. According to the subtypes of reading disabilities, children with dyslexic or mixed types improved after the intervention. @*Conclusion@#Reading accuracy and fluency of school-aged children with reading disorders improved through the intervention program by the schoolteachers.

Effectiveness of Reading Disorder Intervention Program-Open Trial / 신경정신의학

Objectives@#This study investigated the effectiveness of the intervention program for elementary school students with reading disorders. @*Methods@#The intervention program focused on phonological awareness, phonics, and decoding training applied individually to 25 children with a reading disorder by the teachers in charge for four months. To measure the efficacy, this study evaluated the word reading accuracy, fluency, and the related cognitive functions, including phonemic awareness, phonics, and rapid automatized naming using the Computerized Comprehensive Learning Test-Reading before and after the program. @*Results@#After the intervention, improvements were observed in the following: the reading fluency score and fluency percentile in the word attack test; reading accuracy rate, fluency score, and fluency percentile in the nonword decoding test; fluency score and fluency percentile in the rapid automatized naming tests; accuracy rate in the letter-sound matching test; accuracy rate in the nonword repetition test. On the other hand, there was no significant difference in the paragraph reading fluency test. According to the subtypes of reading disabilities, children with dyslexic or mixed types improved after the intervention. @*Conclusion@#Reading accuracy and fluency of school-aged children with reading disorders improved through the intervention program by the schoolteachers.

Mycophenolate Mofetil Overdose Induced Ventricular Tachycardia in a Patient with Systemic Lupus Erythematosus / 대한내과학회지

Mycophenolate mofetil (MMF) is an immunosuppressive agent used to treat severe lupus, including lupus nephritis. Common adverse effects of MMF include gastrointestinal and hematological manifestations; however, cardiac toxicity in association with MMF has not been reported. We present a 21-year-old woman with lupus nephritis who developed ventricular tachycardia 2 hours after an overdose of MMF (34 g). Ventricular bigeminy was documented 12 hours after the MMF overdose. Transthoracic echocardiography showed no evidence of structural heart disease. The ventricular arrhythmia was successfully treated with potassium replacement, hydration, and cholestyramine. This case suggests that an overdose of MMF can induce ventricular tachycardia, and electrocardiogram monitoring is critical to identify this rare cardiac complication of MMF.

Association between Nicotine Dependence and Depressive Mood among Patients of Smoking Cessation Clinic

BACKGROUND: This study evaluated the association between nicotine dependence and depressive mood in patients who visited a secondary hospital for smoking cessation treatment.METHODS: From March 2016 to February 2017, a total of 48 patients who visited the smoking cessation clinic of a secondary hospital in Seoul were surveyed through questionnaires. Nicotine dependence was assessed by the Fagerström Test for Nicotine Dependence. The Beck Depression Inventory (BDI) was used to assess depressive mood.RESULTS: The mean BDI score was positively associated with nicotine dependence (P=0.01). In multivariable logistic regression analysis, increasing BDI was associated with higher odds (1.21, 95% confidence interval; 1.02–1.44) of high nicotine dependence after adjusting for all confounding variables.CONCLUSION: Depressive mood was positively associated with nicotine dependence among patients who visited a smoking cessation clinic. Consideration of depressive mood in smoking cessation treatment may be helpful for smoking cessation among patients with a willingness to quit smoking.

Relationship between the Breakfast and Student's Academic Achievement: Korea Youth Risk Behavior Web-based Survey, 2017

BACKGROUND: Eating breakfast is important for optimal growth and development in adolescence, and is associated with academic achievement as well as nutrition and health status. This study aimed to investigate the relationship between breakfast consumption frequency and high school students' academic achievement.METHODS: We used data from the 2017 Korea Youth's Risk Behavior Web-Based Study, conducted by the Korean Center for Disease Control (64,991 students). The relationship between academic achievement and breakfast consumption frequency was examined using logistic regression.RESULTS: Students who consumed breakfast frequently exhibited higher academic achievement as compared to their counterparts. There was a significant correlation between awareness of appropriate eating habits and breakfast consumption frequency. Further, students who had not received any education about eating habits exhibited low academic achievement.CONCLUSION: To improve the academic achievement of students, they should be motivated to eat breakfast every day. Additionally, appropriate education about eating habits need to be implemented at schools and at home to increase students' breakfast consumption frequency.

Mycophenolate Mofetil Overdose Induced Ventricular Tachycardia in a Patient with Systemic Lupus Erythematosus / 대한내과학회지

Mycophenolate mofetil (MMF) is an immunosuppressive agent used to treat severe lupus, including lupus nephritis. Common adverse effects of MMF include gastrointestinal and hematological manifestations; however, cardiac toxicity in association with MMF has not been reported. We present a 21-year-old woman with lupus nephritis who developed ventricular tachycardia 2 hours after an overdose of MMF (34 g). Ventricular bigeminy was documented 12 hours after the MMF overdose. Transthoracic echocardiography showed no evidence of structural heart disease. The ventricular arrhythmia was successfully treated with potassium replacement, hydration, and cholestyramine. This case suggests that an overdose of MMF can induce ventricular tachycardia, and electrocardiogram monitoring is critical to identify this rare cardiac complication of MMF.

Prevalence of Reading and Mathematical Learning Disabilities in Korean School-Aged Children of Jeju Region / 신경정신의학

OBJECTIVES: This study investigated the prevalence of reading and mathematical learning disabilities of students at primary schools in Jeju Island, South Korea. We examined major causes of learning disabilities including reading disorder, mathematical disorder, attention deficit, and other causes including socioemotional factors. METHODS: We conducted screening processes to 659 participants (340 male, 51%) in 4 elementary schools in Jeju Island. To identify the causes of learning problems, 84 children were administered tests such as the Korean-Wechsler Intelligence Scale for Children-fourth edition, the Comprehensive Learning Test-Reading/Math, and the Comprehensive Attention Test. RESULTS: This study found that 13% of elementary school students in the Jeju region had learning disabilities. Among learning disabilities, specific reading and mathematical disorders accounted for 9% of study subjects. In addition, 2% of participants had intellectual impairment and 1% had other causes such as socioemotional factors. 65% of children with learning disabilities and 74% of children with reading or mathematic disorders had concurrent attention deficit disorder. 68% of children with reading disorders also had comorbid mathematical disorder. CONCLUSION: The prevalence, causes, and comorbidity of reading and mathematical learning disabilities of students in Jeju Island, South Korea did not differ from those in foreign countries. Because most learning disabilities are complex, comprehensive evaluations and tailored interventions are necessary to help children with learning disabilities.

Analysis of Neck Trauma Patients Using the Korean National Emergency Department Information System

PURPOSE: Trauma is a leading cause of death, even in previously healthy and disease-free individuals, and the mortality rate is very high in neck trauma patients. On the other hand, there have been few studies related to neck injuries. This study examined the characteristics and treatment results of trauma-related neck injuries using the data from Korean National Emergency Department Information System. METHODS: Neck trauma patients were classified using the 6th Korean Standard Disease Classification system. The patients' demographic factors, number of surgeries, and clinical results were investigated. Statistical analysis was conducted using SPSS to evaluate the annual differences in the demographic factors; mortality according to the site of injury and type of surgery; and mechanisms of injury. RESULTS: From 2011 to 2014, 2,458 neck trauma patients were treated in hospitals in South Korea. The number of patients admitted to regional and local emergency medical centers was 883 (35.9%) and 1,502 (61.1%), respectively. No significant annual differences were observed in age, sex ratio, location of treatment center, mortality, and injury site (vascular, tracheal, or esophageal). In addition, no significant differences in the cause of injury, performed surgery (%), and mortality according to the injured organ were observed. CONCLUSION: This study revealed no annual changes in neck injury patients or differences in mortality according to injured organs. This study can be used as a basis for national research on organ-specific injuries, and may help predict the demand for future support projects for the establishment of regional trauma centers.

Macromineral intake in non-alcoholic beverages for children and adolescents: Using the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-2009)

The aims of this study were to estimate daily intake of macrominerals from beverages, liquid teas, and liquid coffees and to evaluate their potential health risks for Korean children and adolescents (1-to 19 years old). Assessment of dietary intake was conducted using the actual level of sodium, calcium, phosphorus, potassium, and magnesium in non-alcoholic beverages and (207 beverages, 19 liquid teas, and 24 liquid coffees) the food consumption amount drawn from "The Fourth Korea National Health and Nutrition Examination Survey (2007-2009)". To estimate the dietary intake of non-alcoholic beverages, 6,082 children and adolescents (Scenario I) were compared with 1,704 non-alcoholic beverage consumption subjects among them (Scenario II). Calculation of the estimated daily intake of macrominerals was based on point estimates and probabilistic estimates. The values of probabilistic macromineral intake, which is a Monte-Carlo approach considering probabilistic density functions of variables, were presented using the probabilistic model. The level of safety for macrominerals was evaluated by comparison with population nutrient intake goal (Goal, 2.0 g/day) for sodium, tolerable upper intake level (UL) for calcium (2,500 mg/day) and phosphorus (3,000-3,500 mg/day) set by the Korean Nutrition Society (Dietary Reference Intakes for Koreans, KDRI). For total children and adolescents (Scenario I), mean daily intake of sodium, calcium, phosphorus, potassium, and magnesium estimated by probabilistic estimates using Monte Carlo simulation was, respectively, 7.93, 10.92, 6.73, 23.41, and 1.11, and 95th percentile daily intake of those was, respectively, 28.02, 44.86, 27.43, 98.14, and 3.87 mg/day. For consumers-only (Scenario II), mean daily intake of sodium, calcium, phosphorus, potassium, and magnesium estimated by probabilistic estimates using Monte Carlo simulation was, respectively, 19.10, 25.77, 15.83, 56.56, and 2.86 mg/day, and 95th percentile daily intake of those was, respectively, 62.67, 101.95, 62.09, 227.92, and 8.67 mg/day. For Scenarios I.II, sodium, calcium, and phosphorus did not have a mean an 95th percentile intake that met or exceeded the 5% of Goal and UL.

Preliminary Study for a Multicenter Study of Alzheimer's Disease Cerebrospinal Fluid Biomarkers

BACKGROUND: The usefulness of cerebrospinal fluid (CSF) concentrations of amyloid beta protein 1-42 (Abeta42), phosphorylated tau (pTau) and total tau (tTau) have been increasing in Alzheimer's disease (AD). However, the direct adoption of previously reported standard values is not appropriate due to interlaboratory variability. We started this study to set up an accessible system to measure CSF biomarkers in our country with high reproducibility and validity. METHODS: Including CSFs from four different institutes the levels of Abeta42, pTau181 and tTau were measured in one lab. The intertest variability and difference in the levels of biomarkers depending on diseases were assessed. Through analysis of receiver operating characteristic cut points and binary logistic regression the cut-off values of Abeta42, pTau and tTau level were obtained, and their validity was evaluated. RESULTS: The intertest consistency was high in measuring CSF biomarkers. The value of Abeta42 was markedly decreased in AD (n= 17) and other dementia (n= 9) compared to normal control (n= 12). The levels of pTau181 and tTau were high in AD, but not in other dementia and normal control. The threshold values of Abeta42, pTau181 and tTau were 290.3 pg/mL, 54.3 pg/mL, and 320.7 pg/mL in differentiating AD from normal control showing high sensitivity and specificity. Especially, the ratios of pTau181/Abeta42 (> 0.16) and tTau/Abeta42 (> 0.76) showed the prime validity. CONCLUSIONS: Our data of CSF Abeta42, pTau181, and tTau levels were highly reproducible. PTau181/Abeta42 and tTau/Abeta42 ratios were the greatly helpful in differentiating AD from normal control.

Personal Factors that Affect the Satisfaction of Female Patients Undergoing Esthetic Suture after Typical Thyroidectomy

BACKGROUND: In esthetic surgery, understanding the factors that influence patient satisfaction is important for successful practice. We hypothesize that the factors that influence patient satisfaction include not only aesthetic and functional outcomes, but also personal factors such as the level of familiarity with factors affecting wound healing and expectations regarding aesthetic outcome. METHODS: One hundred patients who underwent esthetic closure after thyroidectomy were included in this study. In order to evaluate the individual characteristics of the patients, a preoperative survey was administered to the patients. We estimated the patient satisfaction six months postoperatively and assessed the aesthetic and functional outcomes using the Patient and Observer Scar Assessment Scale. RESULTS: According to the results of correlation analysis, level of familiarity with wound healing factors had a positive correlation with satisfaction. High expectations, pain, itching, and high observer scale score had negative correlations with satisfaction. The factors that were correlated with satisfaction were included in the multiple regression analysis. Level of familiarity with wound healing factors was found to have a positive relationship with satisfaction, while itching and observer scale were found to have a negative relationship with satisfaction. After excluding 10 patients who had hypertrophic scars, only level of familiarity with wound healing factors and expectations affected satisfaction. CONCLUSIONS: The level of familiarity with factors affecting wound healing and expectations were found to independently affect satisfaction. Improving patients' level of familiarity with wound healing factors and reducing their expectations by providing suitable preoperative education has the potential to improve patient satisfaction.

The Clinical Relationship between Intraocular Pressure and Brain Hemorrhage

PURPOSE: Rapid and noninvasive detection of increased intracranial pressure (IICP) is important in evaluating a clinically unstable, unconscious patient. The purpose of this study was to measure the mean intraocular pressure (IOP) of patients with intracranial hemorrhage and correlate the results to the variable clinical features associated with intracranial hemorrhage. METHODS: Patients admitted to the emergency department were sorted into two groups based on their IOP results as measured using a Tono-Pen. The hemorrhage group consisted of patients suffering with intracranial hemorrhage and the normal group consisted of patients without intracranial hemorrhage. Patients with glaucoma or trauma of the ocular or facial area were excluded from this study. RESULTS: Mean IOP (30.45+/-9.13 mmHg) of the hemorrhage group (52 patients, 34 male, 18 female, mean age 58.28+/-14.39 years) was higher than the mean IOP (16.14+/-2.24 mmHg) of the normal group (39 patients, 23 male, 16 female, mean age 52.69+/-17.79 years) (p<0.001). Whether or not the intracranial hemorrhage was traumatic or nontraumatic, severe, or mild to moderate, accompanied with IICP or non-IICP, requiring an emergency or non-emergency operation, the IOP measured did not show any statistical significance. CONCLUSION: The IOP of the hemorrhage group was higher than the IOP of the normal group, but to determine the clinical usefulness of this measurement when accompanying presentation of headache or traumatic brain injury in the emergency department will require further investigation.

The Clinical Relationship between Intraocular Pressure and Brain Hemorrhage

PURPOSE: Rapid and noninvasive detection of increased intracranial pressure (IICP) is important in evaluating a clinically unstable, unconscious patient. The purpose of this study was to measure the mean intraocular pressure (IOP) of patients with intracranial hemorrhage and correlate the results to the variable clinical features associated with intracranial hemorrhage. METHODS: Patients admitted to the emergency department were sorted into two groups based on their IOP results as measured using a Tono-Pen. The hemorrhage group consisted of patients suffering with intracranial hemorrhage and the normal group consisted of patients without intracranial hemorrhage. Patients with glaucoma or trauma of the ocular or facial area were excluded from this study. RESULTS: Mean IOP (30.45+/-9.13 mmHg) of the hemorrhage group (52 patients, 34 male, 18 female, mean age 58.28+/-14.39 years) was higher than the mean IOP (16.14+/-2.24 mmHg) of the normal group (39 patients, 23 male, 16 female, mean age 52.69+/-17.79 years) (p<0.001). Whether or not the intracranial hemorrhage was traumatic or nontraumatic, severe, or mild to moderate, accompanied with IICP or non-IICP, requiring an emergency or non-emergency operation, the IOP measured did not show any statistical significance. CONCLUSION: The IOP of the hemorrhage group was higher than the IOP of the normal group, but to determine the clinical usefulness of this measurement when accompanying presentation of headache or traumatic brain injury in the emergency department will require further investigation.

Exposure Assessment for Pesticide Residues in Vegetables using Korea National Health and Nutrition Examination Survey Data for Seoulites

The characteristics of pesticide residues were examined in 18,069 samples from 91 vegetable commodities collected in Seoul from 2007 to 2009, and the vegetable dietary intakes of Seoulites were estimated using the Korea National Health and Nutrition examination survey data from 2008. The hazard index was calculated using vegetable pesticide residues and dietary vegetable intake by Seoulites. Detection rates for pesticide residues in vegetables were 11.2 % in 2007, 8.6 % in 2008, and 12.0 % in 2009. Excess rate of Maximum Residue Limits tended to decline from 4.6 % in 2007, to 2.8 % in 2008, and 2.1 % in 2009. Daily vegetable intake for Seoulites was 288.12 +/- 214.8 g, and vegetable intake by males was more than that of females (p < 0.001). The hazard index was the highest at 2.76 x 10(-2) in 2007, and the lowest at 1.69 x 10(-2) in 2009. The risks caused by multiple pesticides in vegetables were very low and vegetable intake was safe considering the hazard index values.

A Case of Aluminum Phosphide Poisoning

Aluminum phosphide is commonly used as a rodenticidal agent in agricultural workplaces. However, reported cases of aluminum phosphide poisoning in Korea are rare. Upon contact with moisture in the air, aluminum phosphide releases highly toxic phosphine gas (PH3). PH3 is readily absorbed through lung epithelium and into the bloodstream. Phosphine may cause denaturing of oxyhemoglobin and enzymes important to respiration and metabolism, and also may effect cellular membranes. There are numerous complications associated with acute aluminum phosphide poisoning including gastrointestinal, respiratory, and cardiac toxicities. We report the case of a 46-year-old man who suffered from respiratory and cardiac toxicities after unintentional aluminum phosphide exposure. More intensive education for prevention is recommended.

Function of Shoulder and Quality of Life between Operation of Thyroid Cancer / 고신대학교의과대학학술지

OBJECTIVES: To determine which factors are changed in the thyroid cancer postoperative care and how quality of life compared between patients who had undergone modified radical neck dissection and selective neck dissection. METHODS: Prospectively, total 151 patients who diagnosed as thyroid cancer and underwent 16 modified radical neck dissection (mRND) or 135 selective neck dissection (SND) were evaluated for shoulder function, neck mobility, and quality of life and degree of depression at baseline, 2 days and 1 week postoperatively. All patients performed neck and shoulder stretching exercise three times a day beginning the morning following surgery. Shoulder function was assessed with the Constant's shoulder scale. Quality of life was assessed with the SF36v2 questionnaire. And depression was assessed with Beck depression inventory (BDI). RESULTS: The disability scores of patients were significantly worse for neck range of motion (ROM), shoulder pain, ADL, shoulder ROM, shoulder abduction power, total score of Constant's shoulder scale, physical function domain in SF-36v2 and BDI score & grade 2 days after the surgeries. SF36v2 domain score was no significantly difference between two groups. CONCLUSION: The mRND and SND are risk factors for neck ROM limitation, shoulder dysfunction, and onset of depression. In comparison between mRND and SND, more deterioration in ADL, shoulder abduction power, total score of Constant's shoulder scale are associated with modified radical neck dissection. More study is needed about usefulness of the stretching exercise in shoulder pain onset through comparison with control group.

The Clinical Characteristics and Mortality Factors of Patients with Hemorrhagic Complications after Anticoagulation Therapy with Warfarin

PURPOSE: The number of patients who take warfarin is growing and so is the number of complications. Hemorrhage is the major complication, but the clinical characteristics and outcomes have not been determined for Korean patients. Therefore, we tried to evaluate the characteristics of the patients with hemorrhagic complications after taking warfarin as anticoagulation therapy. METHODS: We retrospectively reviewed the medical records of the patients who visited the emergency room with bleeding complications after taking warfarin anticoagulation at the out-patient clinic for 1 year from 1st January 2008. We compared between two groups (the major hemorrhage group vs. the minor hemorrhage group) according to the clinical criteria, the unstable vital signs that required blood transfusion, transfusion more than 2 units of blood, the need for further laboratory follow-up, the need for interventional treatment and the development of critical complications or death due to bleeding. RESULTS: There were 150 patients who met the criteria and had acute hemorrhagic complications (the major group: 90 patients and the minor group: 60 patients). In the major hemorrhage group, the frequent sites of bleeding were the gastro-intestinal system (40 patients), lung (14 patients) and intracranium (7 patients). At the emergency room, the major group showed a higher initial INR of the activated prothrombin time than did the minor group (p=0.02). The bleeding sites of the fatal cases were the gastro-intestinal system (3 patients), lung (3 patients) and intracranium (3 patients), but the percentage of fatality was the highest for intracranium bleeding. CONCLUSION: In the major hemorrhage group, gastrointestinal bleeding was the most frequent complication and fatality was the highest for intracranium bleeding. An initially higher INR showed a greater risk of major bleeding, but not more fatalities.

Association of Serum Gamma Glutamyltransferase and Fasting Blood Glucose among Middle Aged and Elderly in Chuncheon: Hallym Aging Study / 가정의학회지

BACKGROUND: Serum gamma-glutamyltransferase (GGT) was reported to be associated with type 2 diabetes, various cardiovascular disease risk factors, and individual components of metabolic syndrome. We performed a cross-sectional study to elucidate the relations between GGT and impaired fasting glucose (IFG). METHODS: The subject of this study included 693 adults (males 272, females 421) aged 45 years or over who have lived in Chuncheon, a suburban small-sized city. IFG was defined as elevated fasting plasma glucose (FPG) concentration of > or = 100 and or = 75th) were 1.0, 0.56, 1.57, and 2.79, respectively (P-value for trend 0.022). In women, the association between the risk of IFG and GGT was not statistically significant. CONCLUSION: This study suggests that elevated level of GGT within the normal range is an independent predictor of impaired fasting glucose in middle-aged or older men but not in women.

A case of complete atrioventricular block persisting for 5 days in a patient with variant angina / 대한내과학회지

Variant angina is more common in Asian people, including Koreans. Variant angina has a broad spectrum of clinical manifestations, from intermittent non-exertional pain to syncope and sudden cardiac death. Complete atrioventricular block is a major cause of syncope in patients with variant angina. The complete atrioventricular block related to variant angina is usually transient and easily terminated immediately after the restoration of coronary blood flow. We experienced a case of variant angina combined with prolonged complete atrioventricular block. The complete atrioventricular block persisted after the restoration of coronary blood flow, but normal sinus rhythm was restored spontaneously 5 days later. Here, we report this rare case