Clinical Usefulness of Contrast-Enhanced Computed Tomography in Patients with Non-Obstructive Acute Pyleonephritis / 고신대학교의과대학학술지

Objectives@#The aim of this study is to investigate the clinical utility of contrast-enhanced computed tomography (CECT) in patient with non-obstrcutive acute pyelonephritis (APN). @*Methods@#From 2007 to 2013, 537 APN patients who underwent a CE-CT scan within 24 hours after hospital admission were enrolled. We divided these patients into greater (50% or greater involvment, n = 143) and lesser (less than 50% involvement, n = 394) groups based on renal parenchymal involvement in CE-CT examination. We compared clinical characteristics between two groups and analyzed the clinical value of CE-CT scan as a reliable marker for predicting clinical severity and disease course in patient with non-obstructive APN. @*Results@#The mean estimated glomerular filtration rate was 70.6 ± 25.5 mL/min/1.73m2. Compared with patients in lesser group, the patients in greater group had lower serum albumin levels (3.5 ± 0.5 vs 3.8 ± 0.6, P < 0.01) and longer hosptal stay (10.1 ± 4.7 vs 8.8 ± 4.5, P < 0.05). In addition, acute kidney injury (AKI) (23.1% vs 11.4%, P < 0.005) and bacteremia (36.4% vs 26.8%, P = 0.02) were frequently developed in greater group, respectively. The overall incidence of AKI was 14.8% based on RIFLE criteria. In a multivariate logistic regression analysis for predciting AKI, age, presence of diabetes mellitus and the presence of renal parenchymal involvement of greater than 50% in CE-CT were significant predictors of AKI. @*Conclusions@#The CE-CT scan could be useful to predict the clinical severity and course in non-obstructive APN patients with preserved renal function.

Association between Insufficient Physical Activity and Hearing Loss in Korean Adults

Background@#Insufficient physical activity is a major risk factor for cardiovascular disease, and some studies report relationship between physical activityand hearing. We aimed to analyze association between hearing loss and physical activity level in Korean adults. @*Methods@#We used data from the 6th Korea National Health and Nutrition Examination Survey. Insufficient physical activity was defined as a combinedphysical activity of less than 150 minutes per week.. Hearing loss was identified when the audible threshold decreased more than 40 dB. Weperformed multiple logistic regression analysis of major covariates and stratified the participants by age (≥60 versus <60). @*Results@#We analyzed 3,237 participants for whom no values were missing. In the final multivariate logistic analysis, the odds ratio of hearing loss was1.227 (95% confidence interval [CI], 1.008–1.494) in the all frequency group and 1.361 (95% CI, 1.073–1.727) in the low frequency group. The resultfor the high frequency group was not statistically significant. In the group aged ≥60 years, the odds ratio of hearing loss in the all, low, and highfrequency groups were 1.277 (95% CI, 1.011–1.613), 1.405 (95% CI, 1.074–1.839), and 1.298 (95% CI, 1.013–1.662), respectively. @*Conclusion@#In this study, insufficient physical activity was associated with hearing loss in Korean adults. This result was more significant in the groupaged ≥60 years. Further studies should aim to validate these results and determine the causal relationship between physical inactivity and hearingloss.

Malignant Melanoma of the Pancreas and Liver Mimicking a Neuroendocrine Tumor / 대한내과학회지

Among metastatic pancreatic tumors, malignant melanomas are rare. Here, we report a very rare case of a malignant melanoma that involved only the pancreas and liver, and was difficult to differentiate from a neuroendocrine tumor of the pancreas with a liver metastasis. A 65-year-old- male with no history of a malignant melanoma exhibited hypervascular hepatic and pancreatic tumors on computed tomography and contrast-enhanced endoscopic ultrasonography. He lacked lesions of the skin, eye, and gastrointestinal tract on physical examination, upper endoscopy, and a whole-body positron emission tomography-computed tomography scan; these sites are common primary sites of malignant melanoma. Finally, endoscopic ultrasound-guided pancreatic core biopsy and percutaneous ultrasonography-guided liver biopsy confirmed malignant melanoma of the pancreas and liver.

Malignant Melanoma of the Pancreas and Liver Mimicking a Neuroendocrine Tumor / 대한내과학회지

Among metastatic pancreatic tumors, malignant melanomas are rare. Here, we report a very rare case of a malignant melanoma that involved only the pancreas and liver, and was difficult to differentiate from a neuroendocrine tumor of the pancreas with a liver metastasis. A 65-year-old- male with no history of a malignant melanoma exhibited hypervascular hepatic and pancreatic tumors on computed tomography and contrast-enhanced endoscopic ultrasonography. He lacked lesions of the skin, eye, and gastrointestinal tract on physical examination, upper endoscopy, and a whole-body positron emission tomography-computed tomography scan; these sites are common primary sites of malignant melanoma. Finally, endoscopic ultrasound-guided pancreatic core biopsy and percutaneous ultrasonography-guided liver biopsy confirmed malignant melanoma of the pancreas and liver.

Regional Differences of Mental Health Status and Associated Factors: Based on the Community Health Survey

OBJECTIVES: The aim of this study was to determine whether there were differences in mental health specific to regions in Korea, and the factors that affected mental health status. METHODS: Data from the 2016 Community Health Survey in Korea were used; 224,421 health survey participants provided responses on mental health issues, demographics, and health behavior, and were included in the study. RESULTS: A statistically significant difference was observed in the incidence of mental health status between different regions of Korea. Independent variables that affected mental health were sex, age, marital status, household income, economic activity, whether living with dementia patients, self-reported health status, smoking, alcohol drinking, sleep time, and chronic diseases. Risk factors associated with symptoms of depression were gender (female), bereavement or being divorced, low household income, family member with dementia, poor self-reported health status, currently smoking, level of physical activity, insufficient hours of sleep and suffering from chronic diseases. CONCLUSION: This study suggests that a standardized healthcare policy is needed to reduce regional variation in mental health. In the future, similar studies that include medical expenses for mental healthcare and relevant variables according to regions of Korea should be conducted.

Regional Disparity and Factors Influencing Unmet Medical Needs: A Study Based on the Sixth Korea National Health and Nutrition Examination Survey (2015)

OBJECTIVES: This study aimed to determine regional differences and the factors that affect unmet medical needs. METHODS: Data from the 6th Korea National Health and Nutrition Examination Survey (2015) were used, and 4,946 health survey participants who provided responses on medical utilization and health behavior were included in the study. RESULTS: A statistically significant difference was observed in the incidence rate of unmet medical needs in terms of region. The independent variables that affected unmet medical needs were sex, age, education, region, household income, insurance type, smoking status, self-reported health status, and stress awareness. Gender (female), lower education level, rural residents, lowest household income, poor self-reported health status, and stress awareness increased the probability of unmet medical needs. CONCLUSION: Our findings suggested that different policies and approaches should be considered for each population that is at risk to address the primary cause of the unmet medical needs. Further studies that include medical expenses and the relevant variables of an area should be conducted in the future.

A Study on the Professional Self-concept, Self Efficacy and Job Satisfaction of Hemodialysis Unit Nurses / 재활간호학회지

PURPOSE: The purpose of this study was to explore the level of professional self-concept, self-efficacy and job satisfaction among nurses who work at hemodialysis units. METHODS: With convenience sampling, 128 nurses working at hemodialysis settings in Chungcheong Province were participated in this study. Data were analyzed using SPSS/WIN 14.0 with descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. RESULTS: The mean scores were 2.68 for professional self-concept, 3.65 for self efficacy and 3.14 for job satisfaction. There were significant differences in professional self-concept according to age, religion, position and clinical experience. There was statistically significant difference in self-efficacy according to age. Also, there was statistically significant difference in job satisfaction according to age, marital status, hospital type, position, clinical experience, and the number of patients per nurse. Job satisfaction was positively correlated with professional self-concept and self-efficacy. CONCLUSION: These findings provided that interventions to enhance professional self-concept as well as the strategies to improve self-efficacy are very important.

Dietary and Non-dietary Factors Related to Bone Mineral Density in Female College Students / 대한지역사회영양학회지

The purpose of this study was to investigate correlations between bone mineral density (BMD) and dietary and nondietary factors in female college students. The BMD of the subjects (n = 38) was measured using DEXA (Dual Energy X-ray Absorptiometry) at lumbar spine and three femoral sites including femoral neck, ward's triangle, and femoral trochanter. Three-day 24-hour dietary recall data were collected from each subject to assess consumption levels of nutrients and food groups. The mean (+/- SD) values of age, age of menarche, height, weight, body mass index (BMI), waist-to-hip ratio (WHR), fat mass, and % body fat of the subjects were 21.34 (+/- 1.73) years, 13.1 (+/- 1.2) years, 161.3 (+/- 5.0) cm, 53.7 (+/- 7.2) kg, 20.6 (+/- 2.6) kg/m2, 0.80 (+/- 0.04), 15.4 (+/- 4.4) kg, and 28.2 (+/- 4.7), respectively. The BMD values of lumbar spine, femoral neck, ward's triangle, and femoral trochanter as T-value were 1.150 +/- 0.13 g/cm2, 0.932 +/- 0.11 g/cm2, 0.850 +/- 0.13 g/cm2, and 0.721 +/- 0.10 g/cm2, respectively. The daily mean energy intake of the subjects was 1660.6 kcal. The intake levels of carbohydrate, calcium, iron, vitamin C, and folic acid were lower than the KDRIs, while those of fat, phosphorus, sodium, vitamin A, and vitamin B6 were higher than the KDRIs. Significantly negative correlation were detected between consumption of fat and oils and the BMD of all sites measured (p < 0.05). Potato and starch intake was negatively correlated to the BMD of femoral neck and word's triangle (p < 0.05). The intake of cereals was found to be negatively correlated to the BMD of ward's triangle (p < 0.05). There was also negative correlation of intake of soybeans and products with the BMD of lumbar spine (p < 0.05). Weight and muscle mass were positively correlated to the BMD of both lumbar spine and femurs (p < 0.01). Significantly positive correlations between BMI, and fat mass and the BMD of lumbar spine were observed (p < 0.001). Additionally fat mass was positively correlated to the BMD of femoral neck. WHR and % body fat were positively correlated to the BMD of lumbar spine (p < 0.05). Negative correlation was found between a serum calcium level and the BMD of femoral neck (p < 0.05). In summary non-dietary factors generally showed significant correlations with the BMD of lumbar spine, while several dietary factors showed significant correlations with the BMD of femurs.

Alterations of Insulin-like Growth Factor-I mRNA and IGF Binding Protein-5 mRNA Expression Following Hypoxic-Ischemic Brain Injury in Immature Rat / 대한소아내분비학회지

PURPOSE:Insulin-like growth factor-I(IGF-I) is an essential anabolic factor for postnatal rat brain development and IGF-I expression is highly abundant during the first 21 days, critical growth period. Hypoxic-ischemic brain insults occurring during the perinatal period result in neuronal necrosis and permanent brain damage. To investigate the regulation of the action of IGF-I in response to such a hypoxic insult, we examined the gene expression of IGF-I and IGFBP-5 during the first 72 hr after hypoxic-ischemic injury in immature rat brain. METHODS:Ligation of the right carotid artery of 7-day-old rats was followed by 2 hour exposure to 8% oxygen to produce severe hypoxic brain damage. Using reverse transcriptase-polymerase chain reaction(RT-PCR), the expression of IGF-I mRNA and IGFBP-5 mRNA was determined in both hypoxic and control brains at post 1, 4, 12, 24, 48 hr and 72 hr after hypoxic-ischemic insult. RESULTS:The IGF-I mRNA and IGFBP-5 mRNA expression of hypoxic brain were not different from those of controls at 1 hr of recovery but IGF-I mRNA expression was decreased rapidly at post 4 hr, this decrease more pronounced at 12 hr of recovery. IGF-I mRNA and IGFBP-5 mRNA expression were increased at 48 hr and 24 hr of recovery, respectively and both IGF-I mRNA and IGFBP-5 mRNA expression showed similar level of controls at 72 hr of recovery. CONCLUSION: Out findings suggest that IGF-I play a important role in both neuronal loss and repair process following hypoxic-ischemic brain injury and IGFBP-5 is also strongly involved in the repair of damaged brain tissue by mediating IGF-I action. (J Korean Soc Pediatr Endocrinol 2003;8:56-63)

Myeloperoxidase Assay on Hypoxic-Ischemic Brain Injury in Immature Rats / 대한소아신경학회지

PURPOSE: Neutrophils found around an infarcted area in the brain was once considered as only the physiologic response following the brain injury, but recent studies have shown that inflammatory responses by neutrophils play an important role in the reperfusion injury. The presence of polymorphonuclear leukocytes(PML) is proven by biochemical assay of myeloperoxidase(MPO) secreted in the cytoplasmic granules. We observed the process of PML infiltration on hypoxic-ischemic brain injury of immature rats by the assay of MPO activity and changes of the MPO activity after the administration of fucoidin, inhibitor of P- and L-selectin. METHODS: We used a well characterized model of the brains of 7 day-old-rats, which had unilateral hypoxic and ischemic injuries(HI). Those injuries were induced by unilateral carotid artery ligation followed by timed exposure to hypoxic inspiratory gas mixture(8% O2). MPO activity was measured in the brain tissue homogenates of HI rats(n=18) at 0, 2, 8, 24 and 48 hrs and in rats that received fucoidin immediately before and again after hypoxia(50 mg/kg, n=6) at 8 and 24 hrs. Controls(n=2) were rats with neither hypoxia nor ischemia. The brain samples were homogenized in 20 mM potassium phosphate buffer(pH 7.4) for 50 secs. The homogenate was centrifuged at 14,000 g at 4degrees C for 15 mins and the supernatant was discarded. The tissue was pulverized, weighed, and suspended in 1 mL of 50 mM potassium phosphate buffer solution(pH 6.0) containing 0.5% cetylditrimethylammonium bromide(wt/vol). The tissue was sonicated and centrifuged at 10,000 g for 15 mins. 200 micro L of the supernatant was mixed with 1 mL of 50 mM potassium phosphate buffer solution(pH 6.0) containing 10 micro L of 1.325 mM o-dianisidine hydrochloride and 170 micro L of 3% hydrogen peroxide(vol/vol). Changes in absorbance at 460 nm were measured for 5 mins by using microplate reader. One unit of MPO activity was defined as that degrading 1 micro mol peroxide/min at 25degrees C, and the result was expressed as units of MPO/100 mg tissue. RESULTS: In HI rats, MPO activity increased at 2 hrs after HI and peaked at 24 hrs in the right hemisphere. In rats with fucoidin treatment immediately before and again after hypoxia, the MPO activity significantly decreased in both hemispheres compared with HI rats(P<0.05). MPO activity in the tissue of control rats was insignificant. CONCLUSION: The dynamic changes of the MPO activity suggest the important role of PMN on hypoxic-ischemic brain injuries in immature rats. MPO activity could be used as an index of the severity of injuries of hypoxic-ischemic brains.

Expression of P-selectin mRNA and Protein on Hypoxic-Ischemic Brain Injury in Neonatal Rat / 대한소아신경학회지

PURPOSE: The selectin family of adhesion molecules plays a role in the initiation of endothelium-leukocyte interaction of inflammation and ischemia-reperfusion. P-selectin, a rapidly expressed endothelial cell adhesion molecule, is essential for both neutrophil rolling after endothelial stimulation and neutrophil transmigration. P-selectins were expressed after brain injury and could play an important role in the pathogenesis of ischemic brain injury in adult animal. However, the mechanisms leading to post-hypoxic-ischemic injury in immature brain are unknown yet. We hypothesize that P-selectin might mediate post-hypoxic-ischemic injury in immature rat brain. We evaluated the expression of mRNA and protein of P-selectin in post-hypoxic-ischemic immature rat brain. METHODS: In isoflurane-anesthetized P7(Postnatal day 7) Sprague-Dawley rats(n=81), the right carotid artery was isolated and coagulated. 1-2 h later animals were exposed to 8% oxygen(balanced with nitrogen) for 2 h in glass chambers, in a warm air incubator (temperature maintained at 36.5 degrees C). Control included carotid artery coagulation alone, hypoxia alone, and normal(neither hypoxia nor coagulation). For RNA extraction, the rats were decapitated at 0, 2, 4, 8, 12, 24 and 48 h after hypoxic-ischemic injury. For Western blot analyses with P-selectin, rats were decapitated at 0, 15, 30 min, 1, 2, 4, 8, 12, 24 and 48 h after hypoxic-ischemic injury. Control or hypoxia alone rats were sacrificed 8 h after the respective intervention. RESULTS: There was no expression of P-selectin mRNA in control groups(carotid artery coagulation alone, hypoxia alone, or normal). P-selectin mRNA expression in the ipsilateral(right) hemisphere reached a peak at 8 h after hypoxia-ischemia and then barely detected after 24 h. Expression of P-selectin protein was not observed in brain tissue of control rats. P-selectin protein was detected as early as 15 min and 30 min at both hemisphere in experimental rats and decreased at 1 h. P-selectin protein increased in right hemisphere at 4 h post-hypoxia-ischemia, peaked at 8 h and no longer detectable at 24 h. CONCLUSION: Hypoxic-ischemic injury leads to P-selectin expression in neonatal rats brain. The temporal profiles of post-hypoxic-ischemic P-selectin mRNA and protein expression are consistent with a role in the evolution of subsequent brain injury.