Association Between Bullying Behavior and Suicidal Ideation Among Middle School Adolescents * / 생물치료정신의학

Objectives@#：This study aimed to investigate the prevalence of bullying behavior and its association with suicidal ideation among middle school students. @*Methods@#：This was a cross sectional study of a sample including 781 second grade middle school students(438 males and 343 females) in Gwang-ju metropolitan city. Information on bullying involvement, suicidal ideation and depressive/anxiety symptoms were collected using a self-administered questionnaire. Subjects were classified into subgroups of bully, victim, bully or victim, bully-victim, and witnessing. The data were analyzed using binary logistic regression analyses, adjusted for covariates. @*Results@#：The prevalence of bullying victimization, bullying perpetration, bullying witnessing and suicidal ideation were 26.5%, 24.5%, 21.6% and 26%, respectively. Suicidal ideation was positively correlated with bullying victimization, bullying perpetration, bullying witnessing. Using binary logistic regression analyses, the odds ratio of bully-victim group compared to non bullying involvement was 2.41, the highest among all groups. @*Conclusions@#：Our findings indicate that school bullying, victim, and witnessing are associated with suicidal ideation, especially in bully and victim group. In addition, it is essential to develop prevention strategies and interventions for adolescents involved in any bullying involvement.

Novel Antihypertension Mechanism of β-Glucan by Corin and ANP-Mediated Natriuresis in Mice

Many of the β-glucans are known to have antihypertensive activities, but, except for angiotensin-converting enzyme II inhibition, the underlying mechanisms remain unclear. Corin is an atrial natriuretic peptide (ANP)-converting enzyme. Activated corin cleaves pro-ANP to ANP, which regulates water–sodium balance and lowers blood pressure. Here, we reported a novel antihypertensive mechanism of β-glucans, involved with corin and ANP in mice. We showed that multiple oral administrations of β-glucan induced the expression of corin and ANP, and also increased natriuresis in mice. Microarray analysis showed that corin gene expression was only upregulated in mice liver by multiple, not single, oral administrations of the β-glucan fraction of Phellinus baumii (BGF). Corin was induced in liver and kidney tissues by the β-glucans from zymosan and barley, as well as by BGF. In addition to P. baumii, β-glucans from two other mushrooms, Phellinus linteus and Ganoderma lucidum, also induced corin mRNA expression in mouse liver. ELISA immunoassays showed that ANP production was increased in liver tissue by all the β-glucans tested, but not in the heart and kidney. Urinary sodium excretion was significantly increased by treatment with β-glucans in the order of BGF, zymosan, and barley, both in 1% normal and 10% high-sodium diets. In conclusion, we found that the oral administration of β-glucans could induce corin expression, ANP production, and sodium excretion in mice. Our findings will be helpful for investigations of β-glucans in corin and ANP-related fields, including blood pressure, salt–water balance, and circulation.

Predictive Value of Serum Procalcitonin in Urinary Tract Infection Patients with Bacteremia

PURPOSE: Urinary tract infection (UTI) is a common disease in the emergency department (ED). In general, UTI could be treated easily without complication. However, UTI with bacteremia can progress to sepsis or severe sepsis and delay of appropriate treatment can result in worse prognosis. Increased serum procalcitonin level in the bacterial infection of ED patients has been proven. The purpose of this study is to examine the clinical utility of procalcitonin as a predictor for bacteremia in UTI patients in the ED setting. METHODS: This is a retrospective cohort study. UTI Patients admitted through the ED of three academic teaching hospitals from January 2010 to December 2012 were enrolled. We investigated demographic characteristics, hemodynamic variables, and laboratory results including serum procalcitonin level at presentation to the ED according to the presence of bacteremia. ROC curve was obtained and multivariate regression analysis was performed to test the predictive value of serum procalcitonin level for bacteremia in UTI patients. RESULTS: A total of 334 patients were enrolled. Bacteremia was proven in 135 UTI patients. UTI patients with bacteremia had significantly higher serum level of procalcitonin (0.830 vs. 6.860, p<0.0001). In multivariable logistic regression analysis, level of procalcitonin and platelet count showed statistical significance (Odds Ratio=1.018, (1.007-1.028), 0.995, (0.992-0.998), 95% CI). Area under the curve for procalcitonin was 0.729, and cut off value was 2.52 ng/ml. CONCLUSION: Serum procalcitonin level could be used as a valuable predictor for the presence of bacteremia in UTI patients visiting the ED.

Effects of Quetiapine on the Immobilization Stress-induced BDNF and CRF Expression in Rat Brain / 대한정신약물학회지

OBJECTIVE: In this study we examined the effects of quetiapine on the immobilization stress-induced brain-derived neurotrophic factor (BDNF) and corticotropin-releasing factor (CRF) expression in rat brain. We also assessed the antidepressant activity of quetiapine. METHOD: We used in situ hybridization to examine the effects of chronic administration of quetiapine in gene transcription. This study also examined the influence of quetiapine in an animal model of depression, the forced swimming test (FST). RESULTS: 1) Repeated immobilization stress (2 hr daily for 3 weeks) decreased mRNA levels of BDNF in the hippocampus (p<0.01), parietal cortex (p<0.01) and pyriform cortex (p<0.05). 2) Repeated immobilization stress increased mRNA levels of CRF in the hypothalamic paraventricular nucleus (PVN)(p<0.01). 3) Chronic quetiapine (10 mg/kg) treatment (daily for 3 weeks) alone significantly increased BDNF mRNA expression in the dentate gyrus of hippocampus when compared to controls under basal conditions (p<0.01), whereas no such effect was observed in the neocortex. 4) Chronic pretreatment of quetiapine also markedly increased the stress-induced decrease of BDNF mRNA expression in the hippocampus (p<0.01) and neocortex (p<0.01). 5) Moreover, the stress-induced elevation of CRF mRNA expression was blocked by chronic quetiapine pretreatment in PVN (p<0.01) although chronic quetiapine treatment alone did not significantly reduce CRF mRNA levels in comparison to controls under basal condition. 6) When rats received acutely quetiapine, quetiapine did reduce the immobility time at 10 mg/kg, as compared with the control group (p<0.05). CONCLUSION : These results suggest that quetiapine has not only potentially an antidepressant effect but also a neuroprotective action in schizophrenia and this effect may be related to its antipsychotic effect in patients with schizophrenia.

Clinical Review of Acute Mesenteric Ischemia

PURPOSE: The purpose of this study was to review our clinical experiences of acute mesenteric ischemic disease at the Masan Samsung hospital. METHOD: Retrospectively reviewed the medical records of 20 patients with acute mesenteric ischemic disease from 1998 through 2003 in terms of clinical characteristics, image findings, management and results. RESULT: The mean age of patients was 63.5 years and the male female ratio was 1.5:1. Coexisting diseases were atrial fibrillation (n=10), hypertension (n=9), myocardial infarction (n=2), DM (n=4). The clinical manifestations were abdominal pain, abdominal distension, peritoneal irritation signs, vomiting and melena. The presenting signs were nonspecific. Laboratory findings were nonspecific and not helpful for diagnosis of acute mesenteric ischemia. Abdominal CT and SMA angiography were accurate and sensitive diagnostic tools. Seventeen cases were SMA occlusion (1 case: SMA dissection) and 3 cases were SMV occlusion. Operative procedures were resection of bowel (12 cases) and thromboembolectomy (5 cases). Non operative procedure was anticoagulation (3 cases). One patient refused surgery. CONCLUSION: Both clinical and laboratory data were non-specific and delayed diagnosis was the main cause of the overall mortality rate of 35% (7 cases). The mortality rate for patients undergoing surgery for acute mesenteric ischemic disease was high, but early diagnosis and intensive care may be reduced mortality.

Clinical Analysis of Above-Knee Femoropopliteal Bypass on Chronic Lower Limb Ischemia

PURPOSE: To elucidate overall aspects of femoropopliteal bypass including patency rate, risk factors for patency and complications. METHOD: We analyzed 61 limbs with atherosclerosis in 57 patients underwent above-knee femoropopliteal bypass surgery from September 1994 to April 2000 retrospectively. The mean age of the patients was 65.3 years (31~80 yr.) Operative indications included disabling claudication (54%), resting pain (11.5%), ischemic gangrene (or ulceration) (34.4%). Associated risk factors were cerebrovascular accident (51%), diabetes mellitus (39%), coronary artery disease (32%), hypertension (30%), hyperlipidemia (16%). We used PTFE (polytetrafluoroethylene) synthetic graft in all cases. Adjunctive procedures were performed in 13 cases, which were iliac artery stent insertion in 7 cases, balloon dilatation in 4 cases, neurolysis in 1 case, profundaplasty in 1 case. RESULT: Overall 1, 3, 5-year primary and secondary graft patency rates were 83.8%, 73.0%, 71.3% and 98.0%, 85.0%, 75.0%. 17 postoperative complications occured including 10 cases of leg edema, 3 cases of myocardiac infarction, 3 cases of cerebral infarction, 1 case of pneumonia. In uni- and multivariate analysis, run off score was the only significant factor influencing primary graft patency rate (p=0.013), but risk factors such as DM, smoking, hyperlipidemia had no statistical significancy on the primary and the secondary graft patency rates. CONCLUSION: We consider that run off score is the most important factor for predicting the graft patency as other studies verified.

Clinical Experiences of the Arterial Bypass in Aortoiliac Occlusive Disease

PURPOSE: To analysis of the clinical aspects of axillofemoral (AXFBG) and aortofemoral bypass (AOFBG) for aortoiliac occlusive disease. METHODS: Between June 1996 and May 2001, 23 patients underwent AXFBG or AOFBG for lower extremity ischemia caused by aortoiliac occlusive disease at Samsung Medical Center. The decision to perform AXFBG or AOFBG was based on an assessment of surgical risk and the patient's preference. We retrospectively analyzed the preoperative clinical status, risk factors and distal runoff scores affecting the patency rate as well as the clinical outcome following surgery. RESULTS: We performed 10 AXFBGs and 13 AOFBGs. The mean age was 67.8 years in AXFBG patients and 57.4 years in AOFBG patients. Limb salvage as an indication for surgery included 8 (80%) cases with AXFBG, as compared to 13(100%) cases with AOFBG. The mean follow-up period was 20.7 months in AXFBG and 21.8 months in AOFBG. The clinical improvement following surgery was statistically higher with AOFBG. The one-year and 2-year primary patency rates in AXFBG were 100% and 82% retrospectively. All of the grafts of AOFBG were patent during this follow-up period. CONCLUSION: The clinical improvement was higher with AOFBG as compared to AXFBG. However AXFBG is a safe practice in high-risk patients.

Analysis of Graft Patency and Risk Factors Influencing Graft Failure in Femorofemoral Crossover Bypass

PURPOSE: Femorofemoral crossover bypass is commonly employed to treat unilateral iliac artery occlusion in chronic limb ischemic patients. We retrospectively analysed the risk factors related to postoperative graft failure and primary patency. METHODS: We reviewed 33 iliac artery occlusion patients who visited Samsung Medical Center between March 1995 and July 2000 and underwent femorofemoral bypass surgery. 33 cases were employed 6 mm or 7 mm PTFE (polytetrafluoroethylene). The average age of the patients was 63.3 year-old, and all of them were male. The indication of surgery were claudication (19 cases, 57.6%), resting pain (9 cases, 27.3%), and lower limb ulceration or gangrene (5 cases, 15.2%) in preoperatively. RESULTS: The average ankle-brachial index (ABI) was 0.34 preoperatively and 0.837 postoperatively. Graft failure after 30 days (late graft failure) was found in 7 cases (21.3%). The primary patency rates were 80.1% for 1 year and 60.1% for 2 years. According to the cross table analysis of the risk factors, smoking, diabetes mellitus, cardiac status, distal run-off score, and cerebrovascular disease related with carotid stenosis showed significantly high rate graft failure. A univariate analysis of risk factors showed that preoperative smoking, diabetes mellitus, hypertension, distal run-off score, cardiac status, and cerebrovascular diseases related with carotid stenosis were significantly related with primary patency. However, according to multivariate analysis, these risk factors did not show any significant relationship with primary patency, with the exception of the distal run-off score (p= 0.0018). CONCLUSION: Continuous and close care of patients through postoperative long-term follow up would improve graft patency in patients with risk factors, such as diabetes mellitus, carotid stenosis, cardiac status, and smoking. Examination of the preopertive distal run off artery will predict the prognosis of the postoperative graft patency.

Factors That Affect the Survival Rate of Ruptured Abdominal Aortic Aneurysm

PURPOSE: Ruptured abdominal aortic aneurysm (RAAA) continue to be a significant causes of death. We review 14 patients who underwent repair of RAAA to analyze the factors affecting the mortality rate. METHOD: Fourteen patients who underwent repair of a RAAA at Samsung Medical Center from March 1995 to July 2001 were reviewed retrospectively. The patients were divided two groups as survival and fatal group. Data was analyzed by both univariate and multivariate analysis. RESULT: There were nine patients (64%) in survival group and five patients (36%) in fatal group. The mean age of survival group was 64.67+/-19.59 years and 67.0+/-5.15 years in fatal group. All patients in fatal group were died within 2 days postoperatively. By univariate analysis of various factors associated with the mortality rate, creatinine level, hemoglobin level were statistically significant. Other factors associated with the mortality rate, albumin, initial systolic blood pressure, initial diastolic blood pressure, operation time, prothrombin time and perioperative platelet count were not statistically significant. CONCLUSION: These findings suggest that creatinine level is predictive of death in repair of RAAA. But patients who have RAAA should not be denied therapy on the basis of any specific criteria of preoperative factors.

Clinical Experience of Iliac Artery Angioplasty with Stent Placement in Chronic Lower Limb Ischemia

PURPOSE: To analysis the results of iliac artery angioplasty with stent placement for the treatment of the chronic lower limb ischemic patients. METHODS: One hundred-six stenotic lesions of the iliac artery (87 male, 4 female, age 42~86) were treated with balloon angioplasty and stent placement from February 1995 through March 1999. All patients were symptomatic including claudication, resting pain and tissue loss. Indications for iliac artery stent placement were long segment stenotic lesion (>3 cm), dissection, failed balloon angioplasty. The pre-stenting and post-stenting clinical records, arteriograms, segmental limb pressure measurements (ankle-brachial and thigh-brachial indexes), and duplex scan were reviewed. The patients were follow up at 1, 3 and 6 month after stent placement and every 6 months thereafter. The Kaplan-Meier survival curve was used to calculate the cumulative patency rates. RESULTS: Patients were followed for up to 45 months (mean 16 months). The technical success rate was 104/106 (98%). The ankle-brachial index or thigh-brachial index improved from 0.64 in pre-stenting to 0.87 in post-stenting. The intraluminal pressure gradient decreased from 21.4 mmHg in pre-stenting to 2.5 mmHg in post-stenting. There was no major complication without 2 immediate stent occlusion. Cumulative primary patencies were 92%, 82%, 74% and 74% at 6, 12, 24 and 36 months. CONCLUSION: Excellent clinical results were achieved for the iliac artery stent placement for the chronic lower limb ischemic patients. Iliac stenting showed low morbidity and mortality rate, and was safe and effective for the treatment of iliac artery occlusive disease.

Mesoatrial Shunt Operation for Treatment of Budd-Chiari Syndrome: A case report

George Budd and Hans Chiari reported the condition of inferior vena cava obstruction combined with hepatic vein or inferior vena cava thrombosis in 1845 and in 1899 respectively, we have defined this condition Budd-Chiari syndrome, which is made up of ascites, hepatomegaly, and abdominal pain. This syndrome develops relatively acute symptoms and is combined with thrombosis of right hepatic vein. In 1950, Bennett reported inferior vena cava obstruction at the level of diaphragm as a similar condition, which clinically has a some different feature that develops symptoms lately, is found splenomegaly commonly, develops ascending collateral vessels, and is companied by membranous obstruction. He defined this idiopathic membranous obstruction of inferior vena cava (MOVC). Recently several cases were reported in Korea since 1978. Budd-Chiari syndrome is rare but may be fatal because of liver cirrhosis and acute hepatic failure without treatment. We reported a case of MOVC treated by mesoatrial shunt with review of literature.

Morphological Study of Effects of Oxidized Low Density Lipoprotein on Three Dimensionally Constructed Vascular Wall

PURPOSE: The purpose of this experiment was to study the effects of Ox-LDL (oxidized low density lipoprotein) and Ox-VLDL (oxidized very low density lipoprotein) with or without probucol treatment on the proliferation of human vascular endothelial cells (EC) which were three dimensionally constructed vascular wall model. METHOD: The thiobarbituric acid reactive substance content of LDL and VLDL oxidized by incubation with copper irons was consistently greater than 10 nM malondialdehyde (MDA)/mg protein compared with less than 3 nM MDA/mg for unmodified lipoprotein immediately after isolation. On agarose gel electrophoresis, Ox-LDL and Ox-VLDL were shown to have greater cationic charge than unmodified lipoprotein. RESULT: In Ox-LDL stimulated ECs, the cellular enzymatic activity was markedly decreased in 50 mug/ml concentration of Ox-LDL and was protected by 10 nM probucol. And in Ox-VLDL stimulated ECs, the cellular enzymatic activity was markedly decreased in 25 and 50 mug/ml concentration of ox-VLDL and was not protected by 10 nM probucol. On scanning electron microscopy (SEM) and transmission electron microscopy (TEM), endothelial layers of control, unmodified LDL and unmodified VLDL groups showed similar appearance. But in Ox-LDL and Ox-VLDL groups, cellular edema, loosened cell-to-cell contact and loss of microvilli were shown on SEM, and marked cellular edema, distortion of cell membrane, loss of intracellular organelles and destruction of nulcleus were shown on TEM. And the protective effect of probucol was definite in Ox-LDL group but in 25 and 50 mug/ml concentration of Ox-VLDL group, there were no protective effects of probucol. CONCLLUSION: As a conclusion, three dimensionally constructed vascular wall model is to be a good experimental model for vascular research. And Ox-LDL and Ox-VLDL have toxic effects on vascular endothelial cell layer and its toxic effects are partially prevented by probucol.

Behcet's Disease with Abdominal Aorta Pseudoaneurysm: A case report

Behcet's disease is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. The etiology and pathogenesis of this disease remain obscure; it is considered an autoimmune disease since vasculitis is the main pathologic lesion and circulating autoantibodies to human oral mucous membrane are found in approximately 50 percent of the cases. Vascular lesions with Behcet's disease may include deep venous thrombosis, superficial thrombophlebitis, arterial obstruction, or arterial aneurysms. Although arterial aneurysmal lesions are uncommon in patients with Behcet's disease, they may pose serious, life-threatening therapeutic problems due to the risk of rupture. Here, we report a case of Behcet's disease, involving abdominal aorta with review of literature.

Absolute Ethanol Sclerotherapy for Cystic Lymphangioma in Neck and Shoulder: A case report

Cystic lymphangioma is congenital anomaly originated from the lymphatic system. It occurs at head and neck area mainly. But its unusual location is possible. Treatment of cystic lymphangioma was surgical removal, but recently nonsurgical approach were studied, including sclerotherapy. Bleomycin, OK-432, and absolute ethanol were used as sclerotherapeutic agents. A 31 year-old female patient was treated by sclerotherapy with absolute ethanol for a cystic lymphangioma in neck and shoulder region. She had detected a mass in neck and shoulder region 8 years ago and had been done excisional surgery twice, 7 years and 4 years ago respectively. She had a 5x4x12 cm sized mass, that was recurred, in her neck and shoulder region. She had sclerotherapy twice in a 3-month interval. Its size decreased 2 cm in diameter from 12 cm.

Clinical Experience with Combination of Selective Embolization and Surgery for Treatment of Congenital Vascular Malformation(CVM)

As for treatment of congenital vascular malfomation (CVM), intra-arterial embolization provide transient symptomatic relief but recurrence of the lesion occurs in most cases and surgical excision alone has great potential risk such as massive bleeding, functional deformity and explosive recurrence. Combination of selective embolization of vascular pedicle and immediate surgical excison offers the best chance for definite results. We report here two cases of sucessful treatment of CVM with combination of N-butyl-2-cyanoacrylate (NBCA) glue in embolization and surgery.

Software for Management of Congenital Vascular Malformation(CVM): A proposal

There is not a unique registry program about the CVM patients in Korea, even in the World. During the business meeting of International Society for the Study of Vascular Anomalies (ISSVA) 1996 in Rome, a sincere discussion took place about the 1988 Hamburg classification of CVM. This was followed by introduction of registry form that could be used universally throughout the world. We developed a CVM registry program calling CVM for world-wide sharing and analysis. This program is a typical database program application system based on Borland's Delphi 1.0 and the database is managed with dBase III+ . It became clear incoporating the Hamburg classification would be natural while expanding the diagnosis and treatment sections. This is a user-friendly, self-explanatory program that hardly needs any tutorial or instruction. Nonthless, for the foolhardy, it comes with manual that explains every aspect of it. Every panel comes with friendly buttons at your service at the stroke of the mouse or the pad. It can be used either on Windows 3.1 or 95, switching back and forth depending on your computer's capability. The program may obtained by diskettes, compact disc or downloaded from the Internet hompage. We will endeavor to upgrade periodcally as necessity arises.