Factor Analysis of the Korean version of Gotland Male Depression Scale * / 생물치료정신의학

Objectives@#：Screening of male depression is important since their symptoms differ from females, such as more common suicide attempts and aggression. Rutz et al. designed the Gotland Male Depression Scale (GMDS) to understand male depression and prevent suicide. The aim of this study is to translate the GMDS into Korean and assess the factor structure of K-GMDS. @*Methods@#：The K-GMDS was administered to 213 male office workers in one public institution. The current study used exploratory factor analysis to validate the factor structure and used confirmatory factor analysis to test the construct validity of five factor models from prior research. @*Results@#：The result indicated that the K-GMDS is characterized by a two-factor structure, different from originally proposed GMDS factor structure and other prior models. Fit indices demonstrated the prior five models to be a poor fit to the data. The internal consistency was demonstrated by a Cronbach’s α of 0.921. @*Conclusions@#：This study can be used as a basis study of male depression, which has not been studied much in Korea. Though factor structure of GMDS reported discrepant findings with prior studies, it would help further development of the scale.

Psychiatric Symptoms in Systemic Lupus Erythematosus: Diagnosis and Treatment

According to the American College of Rheumatology classification, lupus erythematosus has five psychiatric manifestations, including cognitive dysfunction, mood disorder, anxiety disorder, psychosis, and acute confusional state, which are frequently accompanied by other symptoms. Cognitive dysfunction is the most common psychiatric manifestation in lupus patients with a prevalence rate ranging from 20% to 80%. The expression of psychiatric manifestations has been considered to be associated with disease activity, side effects of medications, and/or psychosocial stresses from the chronicity of lupus, but this has not been fully understood. Appropriate management of psychiatric symptoms is essential as it affects treatment adherence and quality of life. This review aimed to facilitate understanding of psychiatric manifestations of lupus through literature review on the prevalence, clinical features, diagnosis, and treatments of each psychiatric symptom.

The Development of Evidence-Based Guideline for Diagnosis and Management of Headache in Korea

OBJECTIVE: We aimed to develop the clinical guideline for headache by the systematic review and synthesis of existing evidence-based guidelines. The purpose of developing the guideline was to improve the appropriateness of diagnosis and treatment of headache disorder, and consequently, to improve patients’ pain control and quality of life. The guideline broadly covers the differential diagnosis and treatment of tension-type headache, migraine, cluster headache, and medication-overuse headache. METHODS: This is a methodological study based on the ADAPTE methodology, including a systematic review of the literature, quality assessment of the guidelines using the Appraisal of Clinical Guidelines for REsearch & Evaluation II (AGREE II) Instrument, as well as an external review using a Delphi technique. The inclusion criteria for systematic search were as follows: topic-relevant, up-to-date guidelines including evidence from within 5 years, evidence-based guidelines, guidelines written in English or Korean, and guidelines issued by academic institutions or government agencies. RESULTS: We selected five guidelines and conducted their quality assessment using the AGREE II Instrument. As a result, one guideline was found to be eligible for adaptation. For 13 key questions, a total of 39 recommendations were proposed with the grading system and revised using the nominal group technique. CONCLUSION: Recommendations should be applied to actual clinical sites to achieve the ultimate goal of this guideline; therefore, follow-up activities, such as monitoring of guideline usage and assessment of applicability of the recommendations, should be performed in the future. Further assessment of the effectiveness of the guideline in Korea is needed.

Psychological Characteristics of Living Liver Transplantation Donors using MMPI-2 Profiles / 정신신체의학

OBJECTIVES: Living donor liver transplantation (LDLT) is a life-saving therapy for patients with terminal liver disease. Many studies have focused on recipients rather than donors. The aim of this study was to assess the emotional status and personality characteristics of LDLT donors. METHODS: We evaluated 218 subjects (126 male, 92 female) who visited Daegu Catholic University Medical Center from August 2012 to July 2018. A retrospective review of their preoperative psychological evaluation was done. We investigated epidemiological data and the Minnesota Multiphasic Personality Inventory-2 questionnaire. Subanalysis was done depending on whether subjects actually underwent surgery, relationship with the recipient, and their gender. RESULTS: Mean age of subjects was 32.19±10.91 years. 187 subjects received LDLT surgery (actual donors) while 31 subjects didn't (potential donors). Donor-recipient relationship included husband-wife, parent-children, brother-sister etc. Subjects had statistical significance on validity scale L, F, K and all clinical scales compared to the control group. Potential donors had significant difference in F(b), F(p), K, S, Pa, AGGR, PSYC, DISC and NEGE scales compared to actual donors. F, D and NEGE scales were found to be predictive for actual donation. Subanalysis on donor-recipient relationship and gender also showed significant difference in certain scales. CONCLUSIONS: Under-reporting of psychological problems should be considered when evaluating living-liver donors. Information about the donor's overall psychosocial background, mental status and donation process should also be acquired.

Gender Differences in the Clinical Manifestation of Depression and Related Neurotransmitters / 생물치료정신의학

Depression is almost twice as prevalent in women than men. Atypical symptoms, somatic complaints, and comorbid anxiety disorders are more common in women, whereas suicide and comorbid substance use disorders are more common in men. Previous studies have also reported gender differences in the efficacy of and tolerability to specific classes of antidepressants. Various psychosocial and biological factors have been proposed to explain the gender differences in clinical characteristics of depression. The predominant theory of depression pathogenesis is the monoamine hypothesis, and consequently, monoamine neurotransmitters have been the primary target of antidepressants. In the first section of this review, study findings of clinical differences in depression by gender are summarized. Then, we provide an overview of the findings from human and rodent studies of gender differences in serotonin, norepinephrine, dopamine, and glutamate neurotransmitter systems. Total level, rate of synthesis, and receptor profiles of neurotransmitters seem to differ by gender in the euthymic state, depressed state, and in responses to stress or antidepressants. Furthermore, these neurotransmitters interact with gonadal hormones and the hypothalamic-pituitary-adrenal axis, systems that innately exhibit gender differences. Although most of the studies conducted so far are limited to animal models and results of the studies are heterogeneous, growing evidence suggests that gender differences exist in neurotransmitter systems, which possibly leads to gender differences in depression. More intensive studies in this field are needed to build gender-specific treatment strategies.

Prevalence and Associated Factors of Depression in General Population of Korea: Results from the Korea National Health and Nutrition Examination Survey, 2014

Depressive disorder is a common mental illness and remains a major cause of morbidity worldwide. The present study, a cross-sectional, nationwide, population-based survey assessed the prevalence of depression in the general population of Korea through a random sampling of the non-institutionalized population for the Korea National Health and Nutrition Examination Survey (KNHANES) VI. The Patient Health Questionnaire (PHQ)-9 was first introduced into the KNHANES to detect depression. The point prevalence of depression (PHQ score of 10 or higher) was 6.7% (95% confidence interval [CI], 5.7–7.6) in 4,949 subjects. Based on the analysis using the diagnostic algorithm of the PHQ-9, the prevalence of major depressive disorder was 2.7% (95% CI, 2.2–3.3). Multiple logistic regression analysis, after adjusting the sociodemographic variables, also showed that the factors associated with depression were perceived stress and health status. This study reported for the first time that the point prevalence of depression screened using the PHQ-9 in this nationwide survey of the Korean population was similar to that of the western countries. As the KNHANES to detect depression is conducted biennially, further studies on the accumulated data are expected in the future.

Does Type D Personality Impact on the Prognosis of Patients Who Underwent Catheter Ablation for Atrial Fibrillation? A 1-Year Follow-Up Study

OBJECTIVE: Although Type D personality has been associated with the prognosis of various cardiac diseases, few studies have investigated the influence of Type D personality on the cardiac and psychiatric prognoses of patients with atrial fibrillation (AF). METHODS: Depression, anxiety, and quality of life were measured at baseline and 6 months. The recurrence of AF was measured during 1-year following radiofrequency catheter ablation (RFCA) for AF. The Kaplan-Meier method with log-rank tests were used to compare the cumulative recurrence of AF. ACox proportional hazard model was conducted to identify factors that contribute to the recurrence of AF. RESULTS: A total of 236 patients admitted for RFCA were recruited. Patients with a Type D personality had higher levels of depression and anxiety and a poorer quality of life compared to controls. Although depression, anxiety, and quality of life had improved 6 months after RFCA, significant differences in psychiatric symptoms remained between patients with and without Type D personality. In the Cox models, the type of AF was the only factor that influenced the recurrence of AF. CONCLUSION: Our results suggest that Type D personality predominately influences psychological distress in patients with AF, but not the recurrence of AF.

A Study for Link of Institution in Disaster Management : Ansan District Study / 정신신체의학

OBJECTIVES: The management of disaster should be immediate and sustainable. Further, it is hard to predict where the disaster will occur, using pre-exists governmental and non-governmental organizations are important. In this study, we tried to investigate the associated activities of organizations performed in Ansan city, in Sewol ferry accident. METHODS: A total 121 workers in 25 organizations were surveyd about organizations which they worked with, kind of works performed, frequency of meetings, satisfaction in activities and factors associated with dissatisfaction in usual state and in Sewol ferry accident state, respectively. The differences between those two situations were analyzed using paired t-test for continuous variables and Chi-square test or McNemar test for categorical variables. RESULTS: The total number of linkage of institutions were decreased(from n=397 to n=251) and the mean scores of rating satisfaction were significantly lower in most of organizations in disaster state. The rigid policy in performance evaluation was more likely associated with dissatisfaction in disaster state than usual state(p=0.045). CONCLUSIONS: For effective linkage of institutions, preparedness, such as understanding the capability of organizations in the communities and developing the protocol for associated activities, is important. The unnecessary and effortful performance evaluation should be sublated.

Clinical Observation Study of Massive Blood Transfusion in a Tertiary Care Hospital in Korea

PURPOSE: Massive blood transfusios are uncommon. The goal of this study was to propose an ideal ratio for the blood component of massive hemorrhage treatment after review of five years of massive transfusion practice, in order to have the best possible clinical outcomes. MATERIALS AND METHODS: We defined a 'massive transfusion' as receiving 10 or more units of red blood cells in one day. A list of patients receiving a massive transfusion from 2004 to 2008 was generated using the electronic medical records. For each case, we calculated the ratio of blood components and examined its relationship to their survival. RESULTS: Three hundred thirty four patients underwent massive transfusion during the five years of the study. The overall seven-day hospital mortality for massive transfusion patients was 26.1%. Factors independently predictive of survival were a fresh-frozen plasma (FFP)/packed red blood cell (pRBC) ratio> or =1.1 with an odds ratio (OR) of 1.96 (1.03-3.70), and elective admission with an OR of 2.6 (1.52-4.40). The receiver operation characteristic (ROC) curve suggest that a 1 : 1 : 1 ratio of pRBCs to FFP to platelets is the best ratio for survival. CONCLUSION: Fixing blood-component ratios during active hemorrhage shows improved outcomes. Thus, the hospital blood bank and physician hypothesized that a fixed blood component ratio would help to reduce mortality and decrease utilization of the overall blood component.

Evaluation of an Automated Instrument, PREVI Isola(R) for Inoculation of Body Fluids and Urine Samples onto Agar Plates

BACKGROUND: In most clinical microbiology laboratories, inoculation of specimens on plates is performed manually and is a time-consuming process. The efficiency of this process can be improved by using an automated instrument. Currently, several automated instruments have been introduced for inoculation of samples. In this study, we have evaluated an automated instrument, PREVI Isola(R) (Biomerieux, France), used for inoculation of body fluids and urine specimens. METHODS: Both manual and automated instrument methods were used to inoculate 74 body fluid and 204 urine samples. Precision was evaluated by testing 3 types of urine samples (A, 6x10(3) colony-forming units (CFU)/mL; B, 3x10(4) CFU/mL; and C, >10(6) CFU/mL) in replicates of 20. Results of the 2 methods were compared by counting the isolated colonies on agar plates after incubation. The time required for both methods was also compared. RESULTS: The coefficient of variation (CV) of samples A, B, and C examined using the automated instrument method was 176.1%, 18.1%, and 12.6%, respectively. The sensitivity and specificity of testing body fluid samples were 77% and 100%, respectively, and those of urine samples were 87% each. The time required for testing 15 body fluid specimens and that for inoculation of each specimen was 9.7 min shorter using PREVI Isola(R) than using the manual method. CONCLUSIONS: The results of body fluid and urine culture by inoculation using the automated instrument, PREVI Isola(R), showed relative good agreement with those obtained using the manual method. The use of PREVI Isola(R) would be expected to reduce the time and labor involved in inoculating various kinds of specimens.

Bacteremia Caused by Corynebacterium amycolatum with a Novel Mutation in gyrA Gene that Confers High-Level Quinolone Resistance / 대한진단검사의학회지

Although Corynebacterium amycolatum can cause opportunistic infections, it is commonly considered as contaminant. In this report, we present a case of bacteremia caused by C. amycolatum with a novel mutation in the gyrA gene that confers high-level quinolone resistance to the organism.

Evaluation of the i-Smart 30 Point-of-Care Analyzer for Use in Clinical Laboratory Settings / 임상검사와정도관리

BACKGROUND: The i-Smart 30 point-of-care (POC) analyzer (i-SENS, Korea) is a compact and portable system used for the analysis of electrolytes (sodium, potassium, chloride) and hematocrit in whole blood samples. In this study, we evaluated the analytical performance of the i-Smart 30 analyzer. METHODS: Precision and sample-related percent carry-over were determined using the quality control materials. Comparison study was performed with the Stat Profile Critical Care Xpress (STP CCX; Nova Biomedical, USA) analyzer using venous whole blood samples. RESULTS: In the precision study, imprecision studies demonstrated within-run and total-run coefficients of variation within 0.5-3.9% and 0.7-4.4%, respectively, for all analytes. A good correlation was found between the i-Smart 30 analyzer and the STP CCX analyzer, except for chloride that showed high intercept. In the study of carry-over, sample-related carry-over for Na+, K+, Cl- and Hct were demonstrated as 0.84%, 0%, 0.86% and 1.56%, respectively. CONCLUSIONS: We conclude that the i-Smart 30 analyzer is suitable for routine use in clinical laboratories, especially where rapid test results are required such as emergency departments, intensive care units, and dialysis units. However, for Cl-, it is necessary that a significant correlation between this analyzer and a reference method should be demonstrated.

Determination of SMN1 and SMN2 Copy Numbers in a Korean Population using Multiplex Ligation-dependent Probe Amplification / 대한진단검사의학회지

Determination of the copy number of the survival motor neuron (SMN) gene is important for detecting spinal muscular atrophy (SMA) carriers and compound heterozygous patients. Multiplex ligationdependent probe amplification (MLPA) assay is a simple and efficient technique used for detecting variations in the copy numbers of different genes. Race- and ethnicity-based variation in the SMA carrier frequency and the '2+0' genotype of SMN1 are important factors that should be considered when estimating the risk of being an SMA carrier. Since SMN2 plays a disease-modifying role, accurate determination of SMN2 copy numbers in SMA patients can serve as a useful prognostic tool. Therefore, information on the SMN2 genotype distributions in normal populations will be helpful in selecting appropriate reference samples for MLPA analysis. To determine SMA carrier frequencies and SMN genotype distribution, we determined the copy numbers of SMN1 and SMN2 genes using the MLPA assay in 100 unrelated Korean individuals with no family history of SMA. The frequency of SMA carriers in the Korean population appears to be 1 in 50, which indicates that the prevalence of SMA among Koreans is the same as that among individuals in the Western countries. Two of the 100 normal individuals enrolled in this study showed 3 copies of the SMN1 gene. Therefore, 1.0% of the 198 normal alleles in this population was estimated to be 2-copy alleles ('2+0' genotype). SMN2 copy numbers showed a high degree of individual variation. Our results showed that 64% of the individuals had 2 copies of SMN2, but 36% individuals had between 0, 1, or 3 copies of the gene.

Evaluation of HbA1c on COBAS INTEGRA 800 Closed Tube System Compared with Variant II Turbo / 임상검사와정도관리

BACKGROUND: We evaluated the HbA1c assay on COBAS INTEGRA 800 Closed Tube System (Roche Diagnostics, USA). METHODS: Precision was determined following Clinical and Laboratory Standards Institute (CLSI) EP5-A2 using the Lyphochek Diabetes Control (Bio-Rad Laboratories, Canada). Two levels of QC materials were assayed in duplicates at two separate times per day for 20 days. The within-run, between-run and between-day precisions were evaluated. We compared the HbA1c of COBAS INTEGRA 800 Closed tube system using Tina quant Hemoglobin A1c Gen.2 (Roche Diagnostics, Germany) reagent with Variant II Turbo (Bio-Rad Laboratories, USA). Bias was determined following CLSI EP9-A2. RESULT: The HbA1c assay on COBAS INTEGRA 800 Closed Tube System showed excellent precision performance: at a level of 5.9%, total, between run, and between day CVs were 1.8%, 0.5%, and 1.6%, respectively. At a level of 9.6%, total, between run, and between day CVs were 1.4%, 0.3%, and 1.1%, respectively. The assay correlated well with the Variant II Turbo (y=0.9x+0.53, r2=0.9857). Mean bias against Variant II Turbo was -0.2%. Compared with Variant II Turbo, the estimate of the predicted bias at a given medical decision level (HbA1c at 6% and 9%) was -0.1% and -0.31%, respectively. CONCLUSIONS: The COBAS INTEGRA 800 Closed Tube System HbA1C assay was precise and equivalent to Variant II Turbo.

First Report of Brain Abscess Associated with Pseudozyma species in a Patient with Astrocytoma / 대한진단검사의학회지

A yeast-like strain was isolated from the brain abscess of a patient diagnosed with astrocytoma. Morphological and molecular analysis on D1/D2 domain in the 26S rRNA gene and internal transcript spacer region of the strain revealed that the strain belonged to the genus Pseudozyma. To the best of our knowledge, this is the first report on the isolation of a Pseudozyma strain from brain abscess.

Differences in Hemoglobin Levels as Measured by Blood Gas and Auto Blood Cell Count Analyzers / 대한수혈학회지

BACKGROUND: While point-of-care testing is being used increasingly as a basis for making decisions about erythrocyte transfusion, no valid standards or guidelines have been developed concerning the accuracy of measuring hemoglobin concentration. METHODS: To compare results from blood gas and auto blood cell count analyzers with respect to hemoglobin, 40 patient blood residual samples which had been withdrawn into 4 mL sodium heparin and EDTA tubes, were analyzed twice by each devices. RESULTS: Passing-Bablok comparisons for hemoglobin (g/dL) with the Nova CCX (y) and Advia 2120 (x) were y=0.877x+2.471 (r=0.985). Additionally, hemoglobin levels from the blood gas analyzer were out of the calculated range at the clinical decision point. CONCLUSION: Blood gas analyzers as point-of care testing exhibited a slightly higher hemoglobin level than auto blood cell count analyzers. Some also produced values of hemoglobin out of the expected range at the clinical decision point. Therefore, the use of blood gas analyzers for hemoglobin levels is limited and it is recommended that the assessment of hemoglobin for transfusion should be determined using auto blood cell count analyzers.

Results of Serologic Screening Tests from Blood Donors at One University Hospital-based Blood Bank during 2006~2008 / 대한수혈학회지

BACKGROUND: Any data on the prevalence of the infectious diseases of blood donors at a university hospital-based blood bank is not available. We aimed to analyze the seroincidence of screening tests from blood donors at a university hospital-based blood bank in Korea. METHODS: We retrospectively analyzed all the samples of blood donors during the previous three years from January 2006 to December 2008. HBsAg and HIV Ab/Ag Combo test were performed by chemiluminescent immunoassays, and anti-HCV was performed by enzyme-linked immunosorbent assay and electrochemiluminescent immunoassay. Serologic testing for syphilis was done by VDRL (venereal disease research laboratory test) and RPR (rapid plasma regain test). RESULTS: The number of total blood donors that underwent screening tests were 1,279 in 2006, 1,355 in 2007 and 941 in 2008, respectively. HBsAg was positive in 8 cases among the 1,279 donors (0.63%) in 2006, in 10 cases of the 1,355 donors (0.74%) in 2007 and in 5 cases of the 941 donors (0.53%) in 2008. Anti-HCV was positive in 3 cases (0.24%) in 2006, 2 cases (0.15%) in 2007 and 2 cases (0.21%) in 2008. One of them was dual positive for HBsAg and anti-HCV. There's no positive case of anti-HIV (0%) during the 3 years. Serologic testing for syphilis (VDRL) was positive in 7 cases (0.55%) in 2006, in 5 cases (0.37%) in 2007 and in 5 cases (0.53%) in 2008. CONCLUSION: The seroincidence was different between a university hospital-based blood bank and the Korean Red Cross Blood Service center. This difference might be due to the composition of donors, i.e., autologous blood donors and directed donors in the university-based blood bank.

A Case of Scedosporium apiospermum Keratitis Confirmed by a Molecular Genetic Method / 대한진단검사의학회지

A 54-yr-old male, who was treated by chemotherapy for gastric cancer 15 months ago, presented to Yongdong Severance Hospital, Seoul, with complaints of pain in his right eye caused by a foreign body from the ground in the previous week. He had been treated with topical and oral antibacterial in addition to antifungal agents, but did not show significant clinical improvement. After a positive corneal culture with mold, topical amphotericin B was added to the initial regimen. The mold was identified as Scedosporium apiospermum by macroscopic and microscopic morphologies and the nucleotide sequences of a fungal PCR product showing 99% homology with those of S. apiospermum (EF151349). He recovered with good results at 25 days after corneal epithelial debridement. The early diagnosis of S. apiospermum keratitis is very important for proper treatment. It is recommended that molecular diagnostic methods such as fungal PCR and sequencing be done with conventional cultures whenever a fungal infection is suspected.