Cognition enhancing effect of panax ginseng in Korean volunteers with mild cognitive impairment: a randomized, double-blind, placebo-controlled clinical trial

This study aimed to investigate the cognition-enhancing effect of Panax ginseng. A randomized, double-blind, placebo-controlled clinical trial was conducted to address the cognition-enhancing effects of Panax ginseng. A total of 90 Korean volunteers with mild cognitive impairment participated in this study. All subjects were allocated randomly into ‘Ginseng’ group or ‘Placebo’ group. All subjects were administered 3g of Panax ginseng powder or starch (placebo) for 6 months. The Korean version of the Mini-Mental Status Examination (K-MMSE), Korean version of Instrumental Activities of Daily Living (K-IADL), and Seoul Neuropsychological Screening Battery (SNSB) were used to assess the changes in cognitive function at the end of the 6 month study period. The subjects of the ‘Ginseng’ group improved significantly on the Rey Complex Figure Test (RCFT) immediate recall (P = 0.0405 and P = 0.0342 in per-protocol (PP) and intention-to-treat (ITT) analysis, respectively) and on the RCFT 20-min delayed recall (P = 0.0396 and P = 0.0355 in PP and ITT analysis, respectively) compared with ‘placebo’ group throughout the 6 months of Panax ginseng administration. There were no serious adverse events. These results suggest that Panax ginseng has a cognition-enhancing effect.

Multiscale Clustering and Profile Visualization of Malocclusion in Korean Orthodontic Patients: Cluster Analysis of Malocclusion

Understanding the classification of malocclusion is a crucial issue in Orthodontics. It can also help us to diagnose, treat, and understand malocclusion to establish a standard for definite class of patients. Principal component analysis (PCA) and k-means algorithms have been emerging as data analytic methods for cephalometric measurements, due to their intuitive concepts and application potentials. This study analyzed the macro- and meso-scale classification structure and feature basis vectors of 1020 (415 male, 605 female; mean age, 25 years) orthodontic patients using statistical preprocessing, PCA, random matrix theory (RMT) and k-means algorithms. RMT results show that 7 principal components (PCs) are significant standard in the extraction of features. Using k-means algorithms, 3 and 6 clusters were identified and the axes of PC1~3 were determined to be significant for patient classification. Macro-scale classification denotes skeletal Class I, II, III and PC1 means anteroposterior discrepancy of the maxilla and mandible and mandibular position. PC2 and PC3 means vertical pattern and maxillary position respectively; they played significant roles in the meso-scale classification. In conclusion, the typical patient profile (TPP) of each class showed that the data-based classification corresponds with the clinical classification of orthodontic patients. This data-based study can provide insight into the development of new diagnostic classifications.

Validation of the Korean version of the 39-Item Parkinson's Disease Questionnaire (PDQ-39)

PURPOSE: To evaluate the reliability and validity of the Korean version of the 39-item Parkinson's disease questionnaire (PDQ-39). METHODS: Cross-cultural adaptation was performed according to the international guidelines: forward and backward translation, focus group meeting, and a field test. With Korean consensus translation produced, validation was assessed by evaluating reliability and validity. Ninety-three outpatients with Parkinson's disease (PD) and 89 healthy aged controls were recruited. Internal consistency reliability was assessed by Cronbach's alpha. Validity was assessed by Spearman correlation analysis, t test, factor analysis, and analysis of variance with Duncan's multiple range tests. RESULTS: In the PD group, mean age was 65.13 +/- 9.84 years, and mean duration of PD was 42.41 +/- 37.01 months. Ceiling and floor effects ranged 1.1%-2.2% and 1.1%-15.1%, respectively. Cronbach's alpha of eight dimensions ranged from .70 to .97. All dimensions were correlated with each other, except for the stigma dimension. PD patients had significantly lower quality of life than healthy aged controls did, except for the bodily discomfort dimension. Eight dimensions of Korean PDQ-39 loaded on one factor. PD patients with a Modified Hoehn and Yarh Staging score of 4 had the worst quality of life. The relationships among the eight dimensions of Koran PDQ-39 and the Modified Hoehn and Yarh Staging is fair to good, except for the stigma and social support dimension. CONCLUSION: The Korean PDQ-39 was proved to be reliable and valid. Our results suggest that Korean PDQ-39 could be used in clinical research to assess and evaluate the disease process and its impacts on health-related quality of life in Korean PD patients.

Multiple Endocrine Neoplasia Type 1 with Multiple Leiomyomas Linked to a Novel Mutation in the MEN1 Gene

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominantly inherited syndrome. MEN1 is characterized by the presence of functioning and nonfunctioning tumors or hyperplasia of the pituitary gland, parathyroid glands, and pancreatic islet cells. In addition, MEN1 carriers can have adrenal or thyroid tumors and non-endocrine tumors, such as lipomas, angiofibromas, and leiomyomas. Although leiomyoma is not a major component of MEN1, it is thought to occur more frequently than expected. However, there has been no report of a case of MEN1 with leiomyoma in Korea so far. This report describes a patient with multiple leiomyomas in MEN1. A 50-year-old woman was referred for further evaluation of elevated calcium levels and osteoporosis. Biochemical abnormalities included hypercalcemia with elevated parathyroid hormone. There was hyperprolactinemia with pituitary microadenoma in sella MRI. An abdominal MRI demonstrated adrenal nodules and leiomyomas in the bladder and uterus. Endoscopic ultrasonography demonstrated esophageal leiomyoma and pancreatic islet cell tumor. A subtotal parathyroidectomy with thymectomy was performed. Sequencing of the MEN1 gene in this patient revealed a novel missense mutation (D350V, exon 7). This is the first case of MEN1 accompanied with multiple leiomyomas, parathyroid adenoma, pituitary adenoma, pancreatic tumor, and adrenal tumor.

Validation of the Korean Version of Liver Disease Quality of Life (LDQOL 1.0) Instrument / 대한간학회지

BACKGROUND/AIMS: Assessment of Health-related quality of life (HRQOL) outcomes in treatment of chronic disease is increasingly important. The objective of this study was to validate a Korean translation of the Liver Disease Quality of Life instrument (LDQOL version 1.0) for use in patients with chronic liver disease. METHODS: Two native Korean speakers with fluent English translated LDQOL including instructions, items, and response choices. This Korean translation of the LDQOL was administered to 121 patients with chronic liver disease. Cronbach's alpha coefficients were applied to test an internal consistency reliability of disease-specific scales of the LDQOL. MELD and modified CTP scores were calculated for all patients. Associations of MELD and modified CTP scores with severity of liver disease were analyzed with LDQOL. RESULTS: Internal consistency reliability was good (Cronbach's Alpha=0.69-0.94) in liver disease specific scales, except for the quality of social interaction scale (Cronbach's Alpha= 0.56). Mean modified CTP score and MELD score were 6.2+/-1.9 and 9.3+/-5.3, respectively. Both MELD score and modified CTP score showed correlations with most of the scores of liver disease specific scales of LDQOL 1.0, except for the quality of social interaction and sleep scale. CONCLUSIONS: The Korean version of the liver disease specific scales of the LDQOL 1.0 is validated and useful for measuring HRQOL in Korean patients with chronic liver disease.

Body Fat Distribution and Blood Pressure according to Anthropometric Change in Korean Patients with Non-Insulin Dependent Diabetes Mellitus(NIDDM) / 간호학회지

PURPOSE: This study was done to identify fat distribution and blood pressure according to anthropometric change patterns between NIDDM patients and control subjects. METHODS: Cross-sectionally 167 NIDDM patients and 87 controls were studied. Previous maximal body weight and acute weight loss was obtained. Current height, body weight, BMI, waist-hip ratio(WHR), skinfold thicknesses(abdomen, subscapular and triceps), and blood pressure was measured. Three anthropometric change patterns were categorized by BMI changes from the maximum lifetim's BMI to the current time (obese-obese, obese-nonobese and nonobese-nonobese: obese: BMI > or =25 kg/m2, nonobese: BMI<25 kg/m2). The data was analyzed by chi-square, t-test, age adjusted ANCOVA and Least Squares Means(LSM) for multiple comparison. RESULT: Acute body weight loss(p=0.01), anthropometric change types (p=0.001), WHR (P=0.05), and skinfold thickness (p=0.002) of NIDDM were significantly higher than those of the controls. The mean arterial pressure, WHR and skinfold thicknesses were greater in both obese-obese and obese-nonobese NIDDM and control subjects compared with both nonobese-nonobese NIDDM and control subjects. (all p's<0.05). CONCLUSION: NIDDM patients had more central and upper body adiposicity. Also both obese-obese and obese-nonobese NIDDM and control subjects had higher mean arterial pressures and central body obesity.

Hepatitis B and C Virus Infection and Liver Dysfunction in Patients Receiving Chemotherapy / 대한소화기학회지

BACKGROUND/AIMS: Liver dysfunction and reactivation of hepatitis virus are well-described complications in cancer patients who receive cytotoxic chemotherapy and may result in varying degrees of liver damage. However, there has been just few reports on such complications and on the preemptive use of lamivudine in Korea. The aims of this study were to determine the prevalence of hepatitis B and C virus infection and the incidence of liver dysfunction in patients with malignancies who receive chemotherapy, to determine the reactivation rate of hepatitis B virus (HBV) in those patients, to evaluate the effect of preemptive use of lamivudine in patients with HBV infection. METHODS: Among 1,477 patients who received chemotherapy due to various malignancies from January 2000 to June 2005, 668 patients with incomplete viral studies or hepatitis related malignancy were excluded. A retrospective study was conducted by reviewing the medical records of remaining 809 patients. RESULTS: The overall prevalence rate of hepatitis B or C virus in patients receiving chemotherapy was 6.55% (53/809). The incidences of liver dysfunction was not significantly different between hepatitis virus positive group and negative group. Reactivation rate of hepatiris B or C virus after chemotherapy was 15% (6/40). In all patients who received lamivudine therapy, aspartate aminotransferase and alanine aminotransferase level were normalized and HBV DNA negativity achieved. CONCLUSIONS: The existence of hepatitis virus in patients receiving chemotherapy did not significantly influence the development of severe liver dysfunction, owing probably to the lamivudine therapy. Further prospective studies are required to ascertain the reactivation of hepatitis virus in patients receiving chemotherapy and the need for prophylactic lamivudine therapy in HBV positive patients.

Cross-Cultural Adaptation and Validation of the Korean Version of the EQ-5D in Patients with Rheumatic Diseases / 대한류마티스학회지

OBJECTIVE: This study is to determine the cross-cultural adaptation and validation of the Korean version of the EQ-5D (KEQ-5D) in various rheumatic patients. METHODS: We performed translation, backward translation and cognitive debriefing by the guidelines of the EuroQol group. The validity was evaluated by using the KEQ-5D, Korean Short- Form 36 (KSF-36) and disease-specific measures on 508 out-patients with ankylosing spondylitis, fibromyalgia syndrome, rheumatoid arthritis, osteoarthritis or systemic lupus erythematosus. Construct validity were evaluated by testing a-priori hypotheses of the association between the KEQ-5D and other measures. For the verification of reliability, we gave the same questionnaires twice to another 57 patients 1-week apart, and intra-class correlations and Kappa statistics were estimated. To test responsiveness, 60 patients with RA repeated the KEQ-5D at 12-week intervals within the context of 12-week clinical trials of a TNF blocker, and we calculated the t-test, effect size and standardized response mean RESULTS: There were no major modifications on the cross-cultural adaptation. The relationships between the KEQ-5D and the generic or disease-specific measures were observed to be as we expected previously in a-priori hypotheses:higher KEQ-5Dindex and KEQ-5DVAS scores were correlated with generic or disease-specific measures on the better health status, and groups with a better functional class showed higher KEQ-5D scores. The intra-class correlations of the KEQ-5Dindex and KEQ-5DVAS were 0.751 and 0.767, respectively, and Kappa statistics for agreement ranged from 0.455 to 0.772 across five dimensions. The standardized response means of KEQ-5Dindex and KEQ-5DVAS were 0.649 and 0.410. CONCLUSION: The KEQ-5D had good validity and sensitivity in several rheumatic conditions. Also, its reliability and responsiveness were moderate to good.

Clinical Significance of Thymidylate Synthase and Methylenetetrahydrofolate Reductase Gene Polymorphism in Korean Patients with Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: Thymidylate synthase (TS) is a target enzyme of 5-fluorouracil (5-FU) and has a polymorphic 28 bp tandem repeated sequence. TS enhancer region (TSER) polymorphism has been associated with the efficacy of 5-FU-based chemotherapy in colon cancer. Methylenetetrahydrofolate reductase (MTHFR) plays a central role in converting folate to methyl donor for DNA methylation. The aim of this study was to determine the clinical value of TSER and MTHFR polymorphism in gastric cancer. METHODS: From October, 1995 to February, 2002, 40 gastric cancer patients underwent operation and 25 patients among those patients have received postoperative 5-FU-based chemotherapy (5-FU (+) group). Peripherial blood were sampled for TSER and MTHFR genotype analysis by PCR amplification of genomic DNA. The survival of patients according to TSER and MTHFR polymorphism were compared. RESULTS: We observed a longer survival in stage II than stage III of the patients (p=0.0037). However, the TSER and MTHFR C677T polymorphisms were not associated with better survival of gastric cancer patients as well as combined TSER and MTHFR genotypes with 5-FU chemotherapy. CONCLUSIONS: The TSER and MTHFR genotypes are not effective markers for tumor sensitivity to 5-FU-based chemotherapy in Korean gastric cancer patients after curative resection. These results may suggest further large-scale study about TSER and MTHFR polymorphism for the prediction of efficacy of 5-FU-based chemotherapy in gastric cancer in Korea.

Perioperative Anticoagulation in Patients with Mechanical Heart Valves Undergoing Elective Surgery: Results of a Survey Conducted among Korean Physicians

The optimal perioperative anticoagulation management in patients on warfarin therapy is poorly defined due to the lack of randomized trials. Because guidelines are heterogeneous, it was hypothesized that "treatment strategies are not uniform in clinical practice". Between February 2003 and May 2003, a questionnaire with 4 different clinical scenarios was distributed to physicians by e-mail, or direct contact was made by a survey monitor. Two scenarios described the cases of patients with a mechanical heart valve (MHV) in the mitral position, with additional risk factors for a systemic embolism; one undergoing major (scenario 1) and the other minor surgery (scenario 3). Two scenarios described patients with an aortic MHV; one undergoing major (scenario 2) and the other minor (scenario 4) surgery. Different preoperative and postoperative management options were offered. The treatment options for all scenarios were the same. Of the 90 questionnaires distributed, 52 (57.8%) were returned. Hospitalization for full-dose intravenous unfractionated heparin (IV UH) was the most commonly selected strategy in the preoperative phase for scenarios 1 (59%), 2 (42%) and 3 (44%). In scenario 4, 34% chose IV UH. Outpatient, full- dose, subcutaneous UH or low-molecular-weight heparin (LMWH) was the most selected option in the postoperative phase for all scenarios, with the exception of number 4 (52.9% in scenario 1, 34% in scenario 2, 32%, in scenario 3 and 28% in scenario 4). Even among expert clinicians, the management of perioperative anticoagulation is heterogeneous. In particular, the definition of risk categories and the optimal intensity of antithrombotic drugs need to be defined by well-designed prospective studies.

Methylenetetrahydrofolate Reductase C677T and A1298C Polymorphisms and Risk of Down Syndrome / 소아과

PURPOSE: The C677T polymorphism of the methylenetetrahydrofolate reductase(MTHFR) has been suggested as a risk factor of maternal meiotic nondisjunction for Down syndrome. Recently, a second genetic polymorphism in MTHFR at position 1298 was reported. However, a positive association between the A1298C MTHFR polymorphism and Down syndrome has not been reported. Therefore, this study was undertaken to determine which polymorphism of MTHFR gene was associated with the increased risk of a child suffering from Down syndrome(DS). METHODS: We enrolled 33 patients with Down syndrome and 100 healthy individuals and analyzed the MTHFR C677T and A1298C polymorphism by a PCR-restriction fragment length assay. RESULTS: Frequencies of MTHFR C677T genotypes(CC, CT, and TT) were 9(27%), 22(67%), and 2 (6%) in the DS patients and 24(24%), 55(55%) and 21(21%) in the control, respectively. The frequency of mutant 677TT was significantly low in the DS patients(OR : 0.14; 95% CI : 0.02-0.95; P= 0.04). For the MTHFR A1298C polymorphism, frequencies of genotypes(AA, AC, and CC) were 16(48 %), 15(45%) and 1(3%) in DS patients and 77(77%), 21(21%) and 2(2%) in the control, respectively. The frequency of mutant 1298AC was significantly increased in DS patients with an odds ratio of 3.3(95% CI : 1.39-7.82; P=0.007). CONCLUSION: Our results suggest that MTHFR mutant 677TT may have a protective effect against Down syndrome, but MTHFR mutant 1298AC may be an independent risk factor in Down syndrome.

Factors Affecting Treatment Response of Disseminated Intravascular Coagulation in Pretem Infants

PURPOSE: Disseminated intravascular coagulation(DIC) occurs most frequently in premature infants. The purpose of this study is to evaluate the influencing factors in treatment of DIC among premature infants. METHODS: A retrospective chart review for 41 premature infants who were admitted to Pochun CHA University neonatal intensive care unit between May 2001 and July 2002 was done. Infants were divided into two groups depending upon their response in improvement of symptoms and laboratory values occurring within or after 72 hours of initiation of therapy. A comparative analysis of various parameter to delineate influencing factors affecting treatment outcome was studied. RESULTS: The factors related to delayed response in treatment of DIC between early response group (19) and late response group (22) included male, low birth weight, severe birth asphyxia, prolongation of prothrombin time, petechiae and oozing of puncture site. CONCLUSION: Awareness of factors associated with delayed response in treatment of DIC may aid in prediction of treatment outcome among premature infants with DIC.

The Relationship between the Bronchopulmonary Dysplasia and Illness Severity (SNAP)

PURPOSE: The objective of this study was to evaluate differences of Scores for Neonatal Acute Physiology (SNAP) in between neonates with bronchopulmonay dysplasia (BPD) and control group, and to utilize SNAP as an early predictive tool for development of BPD. METHOD: A retrospective chart review was done for a total of 30 neonates who were admitted to Pochun CHA University neonatal intensive care unit between April, 1995 and May, 2001. A study group included 15 neonates with BPD and a control group included 15 neonates matched for gestational age and birth weight. SNAP and cumulative SNAP were obtained at 1st, 4th, 6th postnatal day for each group. A comparative analysis of cumulative SNAP scores of various parameters was done in two groups. RESULTS: SNAP of 10.86 and 6.86 were obtained at 4th postnatal day for BPD and control group, respectively (P<0.05). Cumulative SNAP for 1st, 4th, 6th postnatal day were 30.40 and 21.93 in BPD and control group (P=0.059). A comparison of cumulative SNAP of various parameters between two groups showed that respiratory rate and apnea to be significant parameters as well as for blood pressure and arterial oxygen tension in neonates with BPD. CONCLUSION: Score for Neonatal Acute Physiology could be utilized as a tool to predict the development of BPD although larger study is needed to simplify its scoring system to be used easily and better predict the development of BPD.

The Usefulness of B-type Natriuretic Peptide test in Critically Ill, Noncardiac Patients / 결핵

BACKGROUND: Previous studies have suggested that a B-type natriuretic peptide(BNP) test can provide important information on diagnosis, as well as predicting the severity and prognosis of heart failure. Myocardial dysfunction is often observed in critically ill noncardiac patients admitted to the Intensive Care Unit, and the prognosis of the myocardial dysfunction needs to be determined. This study evaluated the predictability of BNP on the prognosis of critically ill noncardiac patients. METHODS: 32 ICU patients, who were hospitalized from June to October 2002 and in whom the BNP test was evaluated, were enrolled in this study. The exclusion criteria included the conditions that could increase the BNP levels irrespective of the severity, such as congestive heart failure, atrial fibrillation, ischemic heart disease, and renal insufficiencies. A triage B-Type Natriuretic Peptide test with a RIA-kit was used for the fluorescence immunoassay of BNP test. In addition, the acute physiology and the chronic health evaluation (APACHE)IIscore and mortality were recorded. RESULTS: There were 16 males and 16 females enrolled in this study. The mean age was 59 years old. The mean BNP levels between the ICU patients and control were significantly different (186.7+/-274.1pg/mL vs. 19.9+/-21.3 pg/mL, p=0.033). Among the ICU patients, there were 14(44%) patients with BNPlevels above 100 pg/mL. The APACHEIIscore was 16.5+/-7.6. In addition, there were 11 mortalities reported. The correlation between the BNP and APACHEIIscore, between the BNP and mortality were significant (r=0.443, p=0.011 & r=0.530, p=0.002). The mean BNP levels between the dead and alive groups were significantly different (384.1+/-401.7 pg/mL vs. 83.2+/-55.8 pg/mL p=0.033). However, the PaO2/FiO2 did not significantly correlate with the BNP level. CONCLUSION: This study evaluated the BNP level was elevated in critically ill, noncardiac patients. The BNP level could be a useful, noninvasive tool for predicting the prognosis of the critically ill, noncardiac patients.

The Application of B-Type Natriuretic Peptide Level of the Dyspneic Patients: Differentiation Between Cor Pulmonale and Left Ventricular Dysfunction / 결핵

BACKGROUND: The serum B-type natriuretic peptide (BNP) is released from the ventricles as a response to volume or pressure overload of the ventricles. A few studies have reported that the BNP measurements are useful in differentiating between heart failure and pulmonary causes in patients who visited the emergency department with dyspnea as the chief complaint. It is difficult to differentiate a right heart failure from a left heart failure in the emergency room. However, there is no report on the application of a BNP assay to differentiate in right heart failure from left heart failure. In this study, the BNP levels were measured from dyspneic patients in the emergency department to determine whether or not the BNP level would be useful in differentiating the cause of the dyspnea from right ventricular failure and left ventricular failure. METHOD: 89 patients who visited emergency department of the Bundang Cha Hospital with dyspnea from June 2002 to March 2003 were selected. The 29 patients from the outpatient clinics and inpatients were randomly selected as the control. RESULTS: The BNP levels of patients in the left heart failure group were significantly different from that of the patients in the right heart failure group (682+/-314 pg/mL vs. 149+/-94 pg/mL, p=0.000). When the BNP cut-off level was designated as 219 pg/mL using the receiver operating characteristic curve, the sensitivity was 94.3%, and specificity was 92.9%. In addition, the positive predictive value was 97% and the negative predictive value was 86.7% in differentiating right heart failure from left heart failure. CONCLUSION: Measurements of the serum BNP levels is an accurate and rapid method that can aid in distinguishing between right heart failure and left heart failure.

Current Status of Health-related Quality of Life Research in Korea / 대한류마티스학회지

OBJECTIVE: This paper reviews the existing Korean medical, nursing and public health academy articles on health-related quality of life, and provides recommendations for the universally validated core quality of life instruments and for wide use of these measures in clinical trials widely. METHODS: A comprehensive review of 116 Korean articles from www.richis.org was conducted. A review of the application, Korean validation, and publishment of Western quality of life instrument from www.QOLID.org. and Medline was conducted in the 116 Korean academic articles. RESULTS: 1. The journal search yielded a total 116 articles, of which 81 were published in Korean nursing academic journal, 35 in medical and public health journals 2. The 4 generic instruments were developed in Korea (1 for middle-aged adult in Seoul, 1 for geriatrics, Korean Quality of Life Scale, Catholic Medical Center Health Survey). The instrument for Korean middle-aged adult was used in 50 Korean articles, but the deletion of items and domains, and change of response scales without conceptual considerations showed. 3. The Korean articles used Western Instruments were 43, of which 13 used generic instruments, 24 used disease-specific, and 2 used domain-specific instruments. 4. The translated instruments in Korean were 4 instruments of COOP-chart, Ferrans and Powers Quality of Life Index-Generic version (QLI), Medical Outcomes Study (MOS) 12-Items Short Form (SF-12), Medical Outcomes Study (MOS) 36-Items Short Form (SF-36) among 33 kinds of quality of life instrument from www.QOLID.org. There was no evidence of publishment internationally on Medline searching. The Korean version of Euro-Qol (EQ-5D) instrument is going on the publishment. 5. Thirteen studies out of 116 Korean articles reported the use of Western Instrument including QLI, WHQOL, General Health Questionnaire (GHQ), COOP-C, COOP-WONCA, Nottingham Health Profile (NHP) and SF-36 among 33 generic quality of life instruments in Korean academic articles. The ommission of international validation step, deletion of items and domains, change of response scales without cultural adaptation and conceptual considerations showed in Korean studies used Western instruments. CONCLUSION: To use the health outcomes instruments universally and to perform multi-national studies, it is suggested that cross-cultural equivalence across all translated versions and conceptual equivalence of translated instruments to the original version must be verified and the quality of life assessment need to be applied to clinical trials.

Current Status of Disease-specific and Domain-specific Health-related Quality of Life Research in Korea / 대한류마티스학회지

OBJECTIVE: This paper reviews the existing Korean medical and public health, and nursing academy articles on disease-specific and domain-specific quality of life, and provides recommendations for the universally validated core quality of life instruments and for use of these measures in clinical trials widely. METHODS: Quality of Life Instruments Database (QOLID) was searched in order to identify all relevant disease-specific, population-specific, and domain-specific QOL instruments. Titles and abstracts of 27 articles related to QOL research conducted by Korean researchers were retrieved from MEDLINE and RICH database. These articles were comprehensively reviewed to analyse the cross cultural adaptation, validation and other aspects of application of Korean version of QOL measures. RESULTS: 1. The journal search yielded a total 27 disease-specific and domain-specific articles, of which 22 were published in Korean nursing academic journal, 5 in medical and public health journals 2. Search for QOLID resulted in 92 specific QOL measures. Thirty-six instruments of which 31 were disease-specific measures, 2 symptom-specific, 2 population-specific, and 1 domain-specific, were translated into Korean language among them. Four Korean version of specific QOL measures were used in articles in MEDLINE. They were Health Assessment Questionnaire (HAQ), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Childhood Health Assessment Questionnaire (CHAQ), and Child Health Questionnaire (CHQ). An article using Korean version of Fibromyalgia Impact Questionnaire (FIQ) is in press. 3. The Korean validated instruments published at international academic articles were HAQ, WOMAC, CHAQ, and CHQ. 4. The Korean version of Parkinson's Disease Questionnaire (PDQ), Kidney Disease Quality of Life Instrument (KDQOL), Functional Assessment of Cancer Therapy (FACT), Functional Assessment of Anorexia/Cachexia (FACTT), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT- F), Functional Assessment of Spiritual Wellbeing (FACT-Sp), and FACT-Anemia are going on Korean validation and data collection under the author contact and permission. 5. Twenty six studies out of 27 Korean articles reported the use of 16 kinds of Western instrument. There were some flaws such as omission of validation steps, deletion of items, arbitrary change of response scale, and absence of cultural adaptation and conceptual consideration in those articles. CONCLUSION: To use the health outcomes disease-specific instruments universally and to perform multi-national studies, it is suggested that cross-cultural equivalence across all translated versions and conceptual equivalence of translated instruments to the original version must be verified and the quality of life assessment need to be applied to clinical trials.

Novel Maintenance Therapy with Lamivudine in Patients with Chronic Active Viral Hepatitis B / 대한간학회지

BACKGROUND/AIMS: This study was conducted to determine the effect of novel long-term maintenance treatment with lamivudine by gradual lengthening of the medication interval in patients with chronic active viral hepatitis B. METHOD: All patients were non-responder, relapsed or intolerable patients to previous interferon therapy. Patients were divided into a drug-interval changing study and a daily continual medication control group. Drug-interval changing protocol with gradual lengthening of the medication interval after conversion to undetectable HBV-DNA in serum and reduction of serum aminotransferase to normal level was monitored monthly. RESULTS: Before treatment, 15 patients of the drug-interval change group and 11 patients of the daily medication group were similar in laboratory and pathologic findings. Mean follow-up periods were 12.8 moths and 11.4 months respectively. HBeAg seroconversion rate was higher in patients in the daily medication group (86.7% vs. 40.0%, p<0.05). The odds of loss of HBeAg, development of anti-HBe, and suppression of HBV-DNA are about 11 times, 7 times, and 8 times higher in the drug-interval change group compared with the daily medication group, respectively (p<0.05). CONCLUSION: Drug-interval lengthening method was effective in long-term suppression of viral replication with low cost.