Diagnostic Value of Anti-Nuclear Antibodies: Results From Korean University-Affiliated Hospitals

Background@#Unnecessary and inappropriate laboratory testing accounts for a significant portion of waste in health care utilization. The aim of this study was to examine the diagnostic value of the anti-nuclear antibody (ANA) test by examining the rate of ANA associated rheumatic disease (AARD) diagnosis among ANA tested and ANA positive subjects and positive predictive value (PPV) of ANA test leading to AARD diagnosis in different ANA titers and different subsets of patients in 5 hospitals affiliated with a university. @*Methods@#We retrospectively extracted data from all subjects who were tested for ANA from year 2010 to 2019. Those who were first evaluated at or referred to rheumatology were further evaluated with extraction of data including ANA titer and ultimate diagnosis. PPVs for ANA test were evaluated after stratification according to clinically relevant key parameters, such as patient age (younger < 65 years vs. older), sex, and requesting department. @*Results@#From 2010 to 2019, A total of 94,153 patients were tested for ANA, of which 13,600 (14.4% of the total) were positive. AARD was diagnosed in only 0.69% among all ANA tested patients and 4.74% among ANA positive patients. The AARD diagnosis rate of ANA positive patients varied widely from 0.1% to 8.7% by requesting department. Using cutoff values above 1:320 yielded PPVs of 15.6 and 7.8% for all AARs and systemic lupus erythematosus.The PPV was significantly higher in young age (< 65 years) and in women, and when it was requested from internal medicine vs other departments. @*Conclusion@#AARD was diagnosed in less than 1% of all ANA tested patients in universityaffiliated hospitals. This result shows that careful consideration before ordering the screening ANA is needed to improve the utility of the test for providers and patients and to reduce health costs spurred by unnecessary testing and its consequences.

Association of Sleep Perception With Objective and Subjective Sleep Variables in Insomnia Patients / 수면정신생리

Objectives@#Our study aims to investigate the clinical and polysomnographic variables associated with subjective sleep perception. @*Methods@#Among the patients who underwent nocturnal polysomnography (PSG) at the Center for Sleep and Chronobiology of Seoul National University Hospital from May 2018 to July 2019, 109 diagnosed with insomnia disorder based on DSM-5 were recruited for the study, and their medical records were retrospectively analyzed. Self-report questionnaires about clinical characteristics including Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI), and Epworth sleepiness scale (ESS) were completed. Subjective sleep quality was measured using variables of subjective total sleep time (subjective TST), subjective sleep onset latency (subjective SOL), subjective number of awakenings, morning feeling after awakening, and sleep discrepancy (subjective TST–objective TST) the morning after PSG. Pearson and Spearman correlation analyses were used to determine the factors associated with subjective sleep perception. @*Results@#In patients with insomnia, subjective TST was negatively correlated with Wake After Sleep Onset (WASO) (p = 0.001) and N1 sleep (p = 0.039) parameters on polysomnography. Also, it was negatively correlated with PSQI (p < 0.001) and BDI (p = 0.014) scores. Sleep discrepancy was negatively correlated with PSQI score (p = 0.018). Morning feeling was negatively correlated with PSQI (p = 0.019) and BDI (p < 0.001) scores. @*Conclusion@#Our results demonstrated that subjective sleep perception is associated with PSG variables (WASO and N1 sleep) and with PSQI and BDI scores. In clinical practice, it is helpful to assess and manage insomnia patients in consideration of objective sleep variables, subjective sleep quality, and depressed mood, which can influence subjective sleep perception.

Decreased Nocturnal Blood Pressure Dipping in Patients with Periodic Limb Movements in Sleep / 수면정신생리

OBJECTIVES: Previous studies have shown that periodic limb movements in sleep (PLMS) could be one of risk factors for cardiovascular morbidity. The purpose of this study was to investigate the association between PLMS and blood pressure changes during sleep. METHODS: We analyzed data from 358 adults (176 men and 182 women) aged 18 years and older who were free from sleep apnea syndrome (Respiratory Disturbance Index 15)]. Blood pressure change patterns were compared using repeated measures analysis of variance. RESULTS: Systolic blood pressure in the high PLMI group was lower than that in the low PLMI group (p = 0.036). These results were also significant when adjusted for gender and age, but were not statistically significant when adjusted for BMI, alcohol, smoking, anti-hypertension medication use and sleep efficiency (p = 0.098). Systolic blood pressure dropped by 9.7 mm Hg in the low PLMI group, and systolic blood pressure in the high PLMI group dropped by 2.9 mm Hg. There was a significant difference in delta systolic blood pressure after sleep between the two groups in women when adjusted for age, BMI, alcohol, smoking, antihypertensive medication use and sleep efficiency (p = 0.023). CONCLUSION: PLMS was significantly associated with a decreasing pattern in nocturnal BP during sleep, and this association remained significant in women when adjusted for age, BMI, alcohol, smoking, antihypertension medication use and sleep efficiency related to blood pressure. We suggest that PLMS may be associated with cardiovascular morbidity.

The Effects of Continuation-Maintenance Electroconvulsive Therapy on Reducing Hospital Re-Admissions in Patients with Treatment-Resistant Schizophrenia

OBJECTIVE: Continuation-maintenance electroconvulsive therapy (C/M-ECT) is used to prevent relapse or recurrence in patients with severe mental illnesses. We aimed to investigate the effect of C/M-ECT on reducing hospital re-admissions in patients with treatment-resistant schizophrenia. METHODS: We applied a mirror-image design by retrospectively examining re-hospitalization rates of 18 patients with schizophrenia spectrum disorders. We compared the numbers of psychiatric admissions during the actual period over which C/M-ECT was administered with the same period prior to the beginning of C/M-ECT. RESULTS: The number of psychiatric admissions was reduced significantly during C/M-ECT (0.33±0.77) compared with that of the same period prior to C/M-ECT (2.67±1.33) (Wilcoxon signed rank Z=−3.663; p < 0.001). CONCLUSION: This finding shows that C/M-ECT augmentation could successfully reduce the re-hospitalization rates in patients with treatment-resistant schizophrenia.

Survey of Insomnia Treatment Status for Doctors / 수면정신생리

OBJECTIVES: The present study investigated current practices of insomnia treatment among Korean doctors in clinical settings. METHODS: A total of 100 doctors participated in the present study and filled out a series of survey questions regarding their treatment of insomnia patients. RESULTS: The results revealed that the primary type of insomnia treatment was pharmacological and that the most popular medication was zolpidem. The majority of doctors reported that they also utilized non-pharmacological treatments such as sleep hygiene education and cognitive-behavioral therapy. However, these treatments tended to result in low satisfaction. In addition, the doctors perceived that patients largely preferred pharmacological treatments to non-pharmacological ones and did not have sufficient knowledge of non-pharmacological treatments. CONCLUSION: Many doctors believed that non-pharmacological treatments for insomnia were important, but reported that they were difficult to implement in practice. The results of this study suggest that improved medical conditions for non-pharmacological treatments and education of physicians are necessary to appropriately treat insomnia.

V-shaped Pits in Regions of Ancient Baekje Kingdom Paleoparasitologically Confirmed as Likely Human-Waste Reservoirs

In a paleo-parasitological analysis of soil samples obtained from V-shaped pits dating to the ancient Baekje period in Korean history, we discovered Ascaris lumbricoides, Trichuris trichiura, and Clonorchis sinensis eggs. In light of the samples' seriously contaminated state, the V-shaped pits might have served as toilets, cesspits, or dung heaps. For a long period of time, researchers scouring archaeological sites in Korea have had difficulties locating such structures. In this context then, the present report is unique because similar kind of the ancient ruins must become an ideal resource for successful sampling in our forthcoming paleoparasitological studies.

Newly Developed Urinary Retention and Motor Weakness of Lower Extremities in a Postherpetic Neuralgia Patient

During the early stage of postherpetic neuralgia, an epidural block on the affected segment is helpful in controlling pain and preventing progression to a chronic state. The main neurologic complication following an epidural block is cord compression symptom due to an epidural hematoma. When neurologic complications arise from an epidural block for the treatment of postherpetic neuralgia, it is important to determine whether the complications are due to the procedure or due to the herpes zoster itself. We report a case of a patient who was diagnosed with herpes zoster myelitis during treatment for postherpetic neuralgia. The patient complained of motor weakness in the lower extremities after receiving a thoracic epidural block six times. Although initially, we believed that the complications were due to the epidural block, it was ultimately determined to be from the herpes zoster myelitis.

Pulmonary aspiration occurring during the induction of anesthesia in a patient with esophageal dilatation / 대한마취과학회지

No abstract available.

Comparison of Anterior and Posterior Elevation, and Sagittal Curvature between Keratoconus and Normal Cornea

PURPOSE: To compare changes of anterior and posterior corneal elevation, and sagittal curvature according to the severity of keratoconus and to compare differences between keratoconus and normal cornea. METHODS: A total of 81 eyes diagnosed with keratoconus and 20 eyes of normal subjects were evaluated with a Pentacam Scheimpflug camera. The keratoconus eyes were divided into 3 groups according to mean keratometer (K): mild (K or =). The following parameters were obtained to evaluate the correlation of keratoconus: corneal thickness, anterior and posterior corneal elevation, and sagittal curvature. RESULTS: Out of 81 keratoconus eyes, 56 eyes were mild, 12 eyes were moderate, and 13 eyes were severe keratoconus. The mean central corneal keratometer, anterior and posterior corneal elevation, and sagittal curvature of the keratoconus eyes were 49.7 D, 22.07 microm, 38.16 microm, 52.76 D and the values increased statistically compared to the normal eyes. Furthermore, the values increased significantly with the severity of keratoconus. ROC curve analysis showed the estimated meaningful value for anterior and posterior corneal elevation and sagittal curvature of keratoconus for diagnosis; there were no diagnostic values for corneal thickness and refractive power. CONCLUSIONS: The index of 5.5 microm for mean anterior elevation, 12.5 microm for mean posterior elevation, and 44.5 microm for mean sagittal curvature using the Pentacam(R) are useful to diagnose keratoconus. Variation of anterior and posterior elevation, and sagittal curvature measured by Pentacam(R) are useful in understanding the process of keratoconus.

Platinum nanoparticles reduce ovariectomy-induced bone loss by decreasing osteoclastogenesis

Platinum nanoparticles (PtNP) exhibit remarkable antioxidant activity. There is growing evidence concerning a positive relationship between oxidative stress and bone loss, suggesting that PtNP could protect against bone loss by modulating oxidative stress. Intragastric administration of PtNP reduced ovariectomy (OVX)-induced bone loss with a decreased level of activity and number of osteoclast (OC) in vivo. PtNP inhibited OC formation by impairing the receptor activator of nuclear factor-kappaB ligand (RANKL) signaling. This impairment was due to a decreased activation of nuclear factor-kappaB and a reduced level of nuclear factor in activated T-cells, cytoplasmic 1 (NFAT2). PtNP lowered RANKL-induced long lasting reactive oxygen species as well as intracellular concentrations of Ca2+ oscillation. Our data clearly highlight the potential of PtNP for the amelioration of bone loss after estrogen deficiency by attenuated OC formation.

Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection for Exudative Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy

PURPOSE: To compare the efficacies of photodynamic therapy (PDT) using verteporfin combined with intravitreal bevacizumab in choroidal neovascularization secondary to age-related macular degeneration and polypoidal choroidal vasculopathy (PCV). METHODS: Photodynamic therapy followed by 3 monthly intravitreal injections of bevacizumab were performed for neovascular age-related macular degeneration (AMD group) and PCV (PCV group). The injections were performed within 2 weeks after PDT and then every 4 to 6 weeks. During the 12-month follow-up period, best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and number of reinjections were reviewed retrospectively. RESULTS: Out of 38 eyes, there were 21 eyes in the AMD group (mean age 66.8 years old) and 17 eyes in the PCV group (mean age 66.4 years old). The average follow-up duration was 17.0 months. At 12 months, the BCVA (logMAR) improved from 0.75 at baseline to 0.49 in the AMD group (p = 0.01) and from 0.81 to 0.63 in the PCV group (p = 0.03). The CSMT decreased significantly from 329 to 231 in the AMD group and from 354 to 223 in the PCV group. At 12 months, 20 eyes (95.2%) in the AMD group and 15 eyes (88.2%) in the PCV group increased or maintained BCVA. The numbers of reinjections were 4.3 in the AMD group and 3.0 in the PCV group. There were no significant differences in BCVA, BCVA changes, CSMT, or number of reinjection between the two groups. CONCLUSIONS: Combined PDT and intravitreal bevacizumab injections showed no significant difference in stabilization of vision or retreatment rates between neovascular age-related macular degeneration and PCV.

Combined Treatment of Photodynamic Therapy and Bevacizumab for Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

PURPOSE: To evaluate the outcome of a combined photodynamic therapy and intravitreal injection of bevacizumab in choroidal neovascularization secondary to age-related macular degeneration. METHODS: Photodynamic therapy (PDT) was administered to 28 eyes followed by 3 consecutive bevacizumab injections. Patients were followed-up for more than 12 months. At baseline, 1, 3, 6, and 12 months post PDT, visual acuity (VA) and central macular thickness were measured using optical coherence tomography. RESULTS: The mean VA was significantly improved from logarithm of the minimal angle of resolution 0.86 at baseline to 0.69 at 1 month (p = 0.011), 0.63 at 3 months (p = 0.003), 0.64 at 6 months (p = 0.004) and 0.60 at 12 months (p < 0.001). Central macular thickness decreased significantly from 328.3 microm at baseline to 230.0 microm at 6 months and 229.9 microm at 1 year (p < 0.001). Reinjection mean number was 0.4 for 6 months and 0.8 for 12 months. By 1 year, retreatment was performed in 10 eyes (36%). CONCLUSIONS: PDT combined with three consecutive intraviteal bevacizumab injections was effective in improving VA and reducing central macular thickness.

Comparison of Results of 2-Hour, 6-Hour and Full-Time Patching Regimens in Treatment of Monocular Amblyopia

PURPOSE: To compare effects of a 2-hour, 6-hour, and full-time patching regimens in monocular amblyopia patients under 10 years of age. METHODS: This study recruited monocular amblyopia patients under 10 years of age. The patients were divided into a 2-hour patching group (group A, n=34), a 6-hour patching group (group B, n=33), and a full time patching group (group C, n=28) according to the patching time. A prospective analysis was then performed. The ages at the start of treatment, differences of corrected visual acuity between the 2 eyes and severity of the 3 groups were compared and analyzed. On the final evaluation, 'success' was defined when the difference of corrected visual acuity between the 2 eyes converted into logMAR was less than 0.1. RESULTS: The ages at the start of treatment in group A, B, C were 5.61, 5.48 and 5.71 years, respectively. The best corrected visual acuity of an amblyopic eye converted into logMAR changed to 0.13 after treatment in group A, to 0.16 in group B and to 0.19 in group C. Although visual acuity after the treatment was increased significantly compared to the beginning of treatment in all 3 groups, the final visual acuity showed no statistically significant difference among the 3 groups. Because the occlusion therapy success rates were 70.6%, 69.7% and 64.3% for groups A, B and C, respectively, there was no statistically significant difference. CONCLUSIONS: In the 2-hour, 6-hour, and full-time patching regimens, all patients showed a significant improvement in visual acuity although their success rates were not significantly different. Therefore, the part-time patching therapy favored by patients and parents is effective for the first treatment of amblyopia.

Fundus Autofluorescence in Acute and Chronic-recurrent Central Serous Chorioretinopathy

PURPOSE: The aim of this study was to evaluate the efficacy and potential value of fundus autofluorescence (FAF) in central serous chorioretinopathy (CSC). METHODS: FAF images were retrospectively evaluated in 122 eyes (119 patients) diagnosed with CSC by fluorescein angiography and OCT. Patients were classified into four groups (normal, mild, moderate, and intense) based on the intensity of FAF. We compared FAF patterns in acute and chronic-recurrent CSC and evaluated the differences in FAF according to the initial best corrected visual acuity (BCVA). We also assessed the differences in subretinal fluid resolution after laser photocoagulation among groups. RESULTS: In the chronic-recurrent group, a significant increase in FAF was observed compared to the acute group (p<0.001). The increase in initial visual acuity in the normal FAF group was statistically significant compared to the other groups (p<0.05). The difference in FAF between patients with acute and chronic-recurrent CSC was not significant. FAF imaging in CSC demonstrates different leakage patterns according to the course of the disease, but the changes in FAF did not correspond to the leakage patterns. In 51 eyes in the group without treatment and in 27 eyes of the focal treatment group, no significant difference was found in subretinal fluid resolution. CONCLUSIONS: FAF could be a non-invasive tool for monitoring RPE changes in central serous chorioretinopathy. FAF imaging could predict recent or former CSC episodes, and this information could be used to predict long-term visual acuity.

Effect of Coexistence of Allergic Rhinitis in Mild Persistent Asthma on Lower Airway Eosinophilic Inflammation / 소아알레르기및호흡기학회지

PURPOSE: Epidemiologic studies have demonstrated that rhinitis and asthma commonly coexist in the same patients and that a temporary relationship exists between the onset of rhinitis and asthma, with rhinitis frequently preceeding the development of asthma. Despite the compelling evidence that rhinitis has a remarkable impact on asthma, it has been controversial how the presence of rhinitis causes asthma to be worsen. We studied to know the effect of coexistence of allergic rhinitis on lower airway eosinophilic inflammation in mild persistent bronchial asthma. METHODS: A total of 129 mild persistent asthmatics were enrolled and divided into three different groups as follows: 37 cases with asthma only; 40 cases with mild allergic rhinitis; and 52 cases with moderate to severe allergic rhinitis. Methacholine challage test and sputum induction were performed and sputum ECP, sputum eosinophils and bronchial hyperresponsiveness (BHR) were compared in each group. RESULTS: In mild asthmatics with moderate to severe allergic rhinitis, the BHR to methacholine increased compared to those with mild or no allergic rhinitis. Eosinophils and ECP in induced sputum were significantly higher in more severe allergic rhinitis groups. We also found a significant correlation between BR index and sputum eosinophils. (gamma=0.578, P< 0.05) CONCLUSION: Our results demonstrated that the severity of allergic rhinitis was related to lower airway eosinophilic inflammation and bronchial hyperresponsiveness in mild persistent asthmatics with allergic rhinitis.

High Frequency Oscillatory Ventilation with Inhaled Nitric Oxide Combined Therapy in The Intractable Respiratory Failure Neonates / 소아과

PURPOSE: Inhaled nitric oxide(iNO) has been known to improve oxgenation in newborns with persistent pulmonary hypertension(PPHN), but it's not clear that iNo treatment is effective in cases of acute, hypoxic respiratory failure and premature infants. In our study, high frequency oscillatory ventilation(HFV) with iNO combined therapy was tried in intractable respiratory failure neonates who showed no response to conventional ventilator therapy. METHODS: Between May 2000 and December 2002, 18 newborns with intractable respiratory failure were treated with HFV with iNO combined therapy. According to the respective response times, the newborns were divided into rapid, intermediate, and non-response groups. Clinical response was defined as when the oxygenation index(OI) was reduced more than 20%. RESULTS: Six neonates(33.3%) showed a rapid response, eight(44.4%) an intermediate response, and four(22.2%) no response. Four had PPHN(22.2%), Three meconium aspiration syndrome(16.7%), three pneumonia(33.3%), and two sepsis(11.1%). Six neonates(33.3%) died, five from respiratory distress syndrome(RDS) and one from sepsis. Of them, one was a full-term neonate and five were premature infants under 35 weeks. Their complications were pneumothorax, pulmonary hemorrhage, pulmonary edema, and congestive heat failure. CONCLUSION: HFV with iNo combined therapy is not effective in intractable respiratory failure, lower gestational age, RDS, and sepsis. However, iNO may be beneficial to patients with acute, hypoxic respiratory failure.

Construction of MAGE - 3 Expressing Plasmid for Development of DNA Vaccine Encoding MAGE - 3 Cancer Antigen / 대한암학회지

PURPOSE: The spectrum of melanoma antigen gene (MAGE)-expressing tumor is very wide and the gene of MAGE express antigens that are targets for specific recognition by cytotoxic T lymphocytes derived from tumor-bearing patients. All of these characteristics represent MAGE as tumor vaccine can be useful for cancer prevention or treatment. Here, we detected MAGE-3 gene expression in cancer cell lines and evaluated recombinant MAGE-3 protein producibility of MAGE plasmid to develope MAGE DNA vaccine. MATERIALS AND METHODS: MAGE-3 gene expression of cancer cell lines was evaluated by reverse transcription-polymerase chanin reaction (RT-PCR). Two kinds of MAGE-3 expressing plasmids were constructed and their MAGE-3 protein producibility was evaluated by immunohistochemistry and immunoblotting using monoclonal anti-MAGE-3 antibody. RESULTS: Among 13 cell lines, SNU484, AMC-HN-3, AMC-HN-4, AMC-HN-7, HeLa, NCI H1703 and HT29 expressed MAGE-3 mRNA. In order to make MAGE plasmid, cDNA that showed 100% DNA homology with MAGE-3 gene was cloned into pcDNA 3 plasmid and pSecTag plasmid. Intracytoplasmic and secretory recombinant MAGE-3 was produced by MAGE-3 containing pcDNA 3 plasmid and pSecTag plasmid, respectively. CONCLUSION: In this study, we showed high expression frequency of MAGE-3 in cancer cell line, and established two kinds of plasmid that produce recombinant MAGE-3 in cell lines. We expect these plasmids will be used in cancer treatment or MAGE-3 function study in future.

Applicability of Genes of Cancer-associated Testis Antigens in Diagnosis of Cancer / 대한면역학회지

Genes of cancer-associated testis antigens (CTAs) are expressed in various cancer tissues. In order to use CTAs as cancer diagnosis marker, we developed molecular method for detection of CTAs transcripts in tissue. In order to know the applicability of DNA of cancer-associated testis antigens (CTAs) on cancer diagnosis, molecular diagnostic methods for detection of gene expression of melanoma antigen gene (MAGE), GAGE, and B melanoma antigen (BAGE) was studied. After comparing DNA sequences of CTAs, S1/AS1 and S2/AS2, GAGE-S/ GAGE-AS, and BAGE-S/BAGE-AS primers were designed for the detection of MAGEs, GAGEs and BAGEs, respectively. The gene expression of CTAs in cancer cell lines, head and neck cancer tissues, ovary cancer tissue, and peritoneal cells of gastric cancer patients were investigated by reverse transcription-polymerase chain reaction (RT-PCR) using these primers. The MAGEs, GAGEs and BAGE genes were expressed in 8/8 (100%), 5/8 (62.5%) and 1/8 (12.5%) of head and neck cancer tissues, respectively. The gene expression of MAGEs were also detected in 8/10 (80%) of ovary cancer tissues and in 9/10 (90%) of peritoneal cells of gastric cancer patients in RT-PCR test using S1/AS1 primers. The results of this study suggest that molecular diagnosis method using CTAs genes, especially RT-PCR using S1/AS1 primer combination, is useful for diagnosis of cancer and it will be used for the prediction of cancer progression or regression and metastasis in future.

An Analysis of Patients whom Were Experienced by Family Resident of Dept. of FM at Eup, city, Capital

No abstract available.

Sleeve tracheal resection and end to end anastomosis with suprahyoid release for the circumferential tracheal stenosis / 대한이비인후과학회지

No abstract available.