Experience of Mental Healthcare Services by Family Caregivers of Patients With Mental Disorders / 신경정신의학

Objectives@#This study was conducted to examine the obstacles in the use of healthcare from the perspective of family caregivers based on their experience of mental healthcare services and to identify practical recommendations according to the family’s needs. @*Methods@#A focus group interview was conducted with 59 family caregivers of patients with mental disorders. They were asked about the first moment when they took the patient to a psychiatric hospital, their feelings, and experiences during the treatment, relapse or readmission, access to healthcare and obstacles. The results were analyzed in a three-step procedure using grounded theory analysis. @*Results@#The results showed that the social prejudice and stigma toward mental disorders experienced by the family caregivers hindered the initial treatment approach. Discrimination and disadvantages in healthcare, and poor access to community mental healthcare services, lowered the reliability of institutions and services. A decrease in the sense of healing due to distrust in the treatment and disruption of family life can lead to a vicious circle that affects the continuity of treatment and could result in issues such as the stopping of treatment or difficulty in accessing treatment in case of relapse. @*Conclusion@#Based on these results, policy tasks were proposed to improve accessibility to mental health services according to the needs of the patient’s family.

Comparison of Pharmacodynamics between Tegoprazan and Dexlansoprazole Regarding Nocturnal Acid Breakthrough: A Randomized Crossover Study

Background/Aims@#Tegoprazan, a novel potassium-competitive acid blocker, is expected to overcome the limitations of proton pump inhibitors and effectively control nocturnal acid breakthrough. To evaluate the pharmacodynamics of tegoprazan versus dexlansoprazole regarding nocturnal acid breakthrough in healthy subjects. @*Methods@#In a randomized, open-label, single-dose, balanced incomplete block crossover study, 24 healthy male volunteers were enrolled and randomized to receive oral tegoprazan (50, 100, or 200 mg) or dexlansoprazole (60 mg) during each of two administration periods, separated by a 7- to 10-day washout period. Blood samples were collected for pharmacokinetic parameter analysis; gastric monitoring was performed for pharmacodynamic parameter evaluation. @*Results@#All 24 subjects completed the study. Average maximum plasma concentration, area under the plasma concentration–time curve, and mean time with gastric pH >4 and pH >6 for tegoprazan demonstrated dose-dependent incremental increases. All the tegoprazan groups reached mean pH ≥4 within 2 hours, whereas the dexlansoprazole group required 7 hours after drug administration. Based on pharmacodynamic parameters up to 12 hours after evening dosing, 50, 100, and 200 mg of tegoprazan presented a stronger acid-suppressive effect than 60 mg of dexlansoprazole. Moreover, the dexlansoprazole group presented a comparable acid-suppressive effect with the tegoprazan groups 12 hours after dosing. @*Conclusions@#All the tegoprazan groups demonstrated a significantly faster onset of gastric pH increase and longer holding times above pH >4 and pH >6 up to 12 hours after evening dosing than the dexlansoprazole group.

Lodoxamide Attenuates Hepatic Fibrosis in Mice: Involvement of GPR35

A previous pharmacogenomic analysis identified cromolyn, an anti-allergic drug, as an effective anti-fibrotic agent that acts on hepatocytes and stellate cells. Furthermore, cromolyn was shown to be a G protein-coupled receptor 35 (GPR35) agonist. However, it has not been studied whether anti-fibrotic effects are mediated by GPR35. Therefore, in this study, the role of GPR35 in hepatic fibrosis was investigated through the use of lodoxamide, another anti-allergic drug and a potent GPR35 agonist. Longterm treatment with carbon tetrachloride induced hepatic fibrosis, which was inhibited by treatment with lodoxamide. Furthermore, CID2745687, a specific GPR35 antagonist, reversed lodoxamide-mediated anti-fibrotic effects. In addition, lodoxamide treatment showed significant effects on the mRNA expression of collagen Iα1, collagen Iα2, and TGF-β1 in the extracellular matrix. However, a transforming growth factor α (TGF-α) shedding assay revealed lodoxamide not to be a potent agonist of mouse GPR35 in vitro. Therefore, these results showed anti-fibrotic effects of lodoxamide in mice and raise concerns how lodoxamide protects against liver fibrosis in vivo and whether GPR35 is involved in the action.

The Effect of Behavioral Relaxation Training on Distress and Cancer Screening Intention of Patients with Upper Gastrointestinal Endoscopy / 한국간호교육학회지

PURPOSE: This study evaluates the effect of behavioral relaxation training on distress and cancer screening intention of patients with upper gastrointestinal endoscopy.METHODS: The research was conducted in a non-equivalent control group posttest design. Data were collected from endoscopy subjects in B city from October to November of 2018. Fifteen minutes of behavioral relaxation training were provided to the experimental group (n=40) and traditional relaxation therapy methods were provided to the control group (n=40). Outcome measures were distress and cancer screening intention of patients with upper gastrointestinal endoscopy. Data were analyzed with a χ²-test, independent t-test, Fisher's exact test with SPSS/PC version 23.0.RESULTS: The objective discomfort (t=8.81, p<.001) of the experimental group was lower than that of the control group; there were no significant differences in the subjective discomfort (t=1.73, p=.088). The cancer screening intention (t=−5.85, p<.001) of the experimental group was significantly higher than that of the control group.CONCLUSION: Behavioral relaxation training was effective in heightening cancer screening intention. Therefore it can be usefully applied to increase cancer screening intention.

Consumer knowledge regarding country-of-origin labeling for restaurants / 한국영양학회지

PURPOSE: Because of recent global and domestic issues regarding the safety of food, there is growing concern over food safety and interest in the country-of-origin for food ingredients from restaurants. This study was conducted to reveal the influence of consumer level of knowledge and awareness regarding restaurants and the country-of-origin labeling. METHODS: To accomplish this, a primary survey of adults aged over 20 years old was conducted to measure customers' knowledge regarding country-of-origin labeling for restaurants. Respondents were then divided into a lower group and an upper group based on their level of knowledge to evaluate significant differences between groups. A total of 437 of 460 questionnaires were analyzed. RESULTS: The average knowledge score regarding country-of-origin labeling for restaurants was 6.3 out of 10. Additionally, there were significant differences between the lower and upper group in terms of the final education level and occupation. CONCLUSION: It is necessary to develop guidelines and public relations for country-of-origin labeling of restaurants.

Reader's Forum / 대한치과교정학회지

No abstract available.

Sleep Patterns in Children with Attention-Deficit/Hyperactivity Disorder by Polysomnography / 대한정신약물학회지

OBJECTIVE: Sleep problems are a prominent feature in children with attention-deficit/hyperactivity disorder (ADHD) and about 25-43% of ADHD patients were reported to have sleep problems including higher level of nocturnal activity, longer sleep latency, lower sleep efficiency, more frequent night awakenings and shorter total sleep time. However, the association between sleep and ADHD is poorly understood and their relationships to sleep structure are not consistent across studies. The aims of our study were to ascertain the nocturnal sleep disturbances in patients with ADHD by objective measure, polysomnography. METHODS: The subjects were 20 patients with ADHD and 21 control children (6-12 years). We tested them by polysomnography to get sleep variables and compare sleep disturbances. In addition, we tested ADHD group by neurocognitive function test and assessed the correlation between sleep variables and neurocognitive functions in ADHD group. RESULTS: In sleep variables by polysomnography, the total time in bed (509.73+/-24.56 min vs. 490.51+/-20.71 min, p=0.01), sleep latency (21.30+/-19.33 min vs. 10.72+/-7.26 min, p=0.031) and limb movement arousal (6.56+/-2.19 /hr vs. 5.98+/-1.38 /hr, p=0.043) were significantly increased in patients with ADHD compared with controls. And the slow wave sleep (24.59+/-4.73% vs. 28.45+/-5.63%, p=0.023) were significantly decreased in patients with ADHD compared with controls. There were no significant differences in sleep period time and sleep efficiency test. CONCLUSION: The patients with ADHD had more sleep problems and results of this study suggested that they have significantly increased the total time in bed, sleep latency and Limb movement arousal. And in the patients with ADHD, some sleep variables indicated poor sleep quality. However, further studies should repeatedly suggest consistent results about sleep problems in children with ADHD.

Usefulness of the Computed Tomography Venography for Evaluation of Leg Edema Including Deep Vein Thrombosis in Rehabilitation Patients

OBJECTIVE: To investigate the usefulness of computed tomography venography (CTV) for evaluation of leg swelling, especially deep vein thrombosis (DVT), in rehabilitation patients. METHODS: A hundred twenty-three patients, who had performed CTV performed because of suspected DVT in our clinic, were enrolled. We performed chart reviews retrospectively and categorized CTV findings as follows: DVT distal to inguinal ligament and no compression lesion; DVT proximal to inguinal ligament and no compression lesion; DVT distal to inguinal ligament and anatomical variant (for example, May-Thurner syndrome); DVT due to compression of mass (cancer or cyst); DVT and other incidental abnormal finding; and no DVT and other possible causes of leg swelling. RESULTS: DVTs were found in 65 (53%) patients. DVTs were found at distal level (thigh or lower leg) to inguinal ligament in 47 patients. DVTs were found at proximal to inguinal ligament, usually undetectable with duplex ultrasonography, in 6 patients. DVTs caused by external compression, such as femoral vein and cancer mass, were found in 12 patients (10%), which are also not easily detected with duplex ultrasonography. Other various causes of leg edema without DVT were found in 22 (18%) patients. CONCLUSION: CTV can evaluate more extensively venous problems in the pelvis and abdomen and detect other possible causes of leg swelling. Therefore, CTV can be a useful tool not only for easy detection of DVT but also for evaluating differential diagnosis of leg edema in rehabilitation patients.

Perilesional Steatosis in Ectopic Pancreas Mimicking Exogastric Mass : A Case Report

We report an unusual case of ectopic pancreas that appeared on radiologic images as a lobulated, submucosal mass enclosed by fat component in the gastric lower body. Although, ectopic pancreas including fat component is extremely rare, in the setting of gastric submucosal mass with containing perilesional fat, these findings should be considered in ectopic pancreas as part of the differential diagnosis.

Rituximab and Plasmapheresis for Post-transplant Recurrence of FSGS / 대한신장학회지

Focal segmental glomerular sclerosis (FSGS) is known to recur in 20-40% of the renal allografts with graft loss in about half of these cases. We report a successful treatment of a recurrent FSGS after kidney transplantation with rituximab and plasmapheresis. An 16-year-old patient whose primary kidney disease was FSGS developed recurrence of proteinuria after living donor kidney transplantation despite preemptive plasmapheresis and one dose of rituximab (375 mg/m2). After kidney transplantation, nephrotic range proteinuria was detected. Kidney biopsy was done and showed recurrent FSGS. She undergone 11 times of plasmapheresis in the first 4 week post transplantation. In addition, she received additional one dose of rituximab (375 mg/m2) on day 14. Proteinuria was decreased below nephrotic range at 37 day. Ten months later, proteinuria was at 30 mg/day with excellent graft function. No significant adverse events related to rituximab or plasmapheresis were observed. Rituximab with plasmapheresis may be another option for recurrent FSGS after kidney transplantation.

Colonization Rate and Control of Vancomycin-Resistant Enterococci in the Neonatal Intensive Care Unit / 소아감염

PURPOSE: Recently, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in Korea. However, there have been few studies on the epidemiology of VRE colonization among neonates. In this study, we investigated the prevalence of VRE colonization, risk factors for VRE, and how to control the spread of VRE infection in the Neonatal Intensive Care Unit (NICU) of Pusan National University Hospital (PNUH). METHODS: We retrospectively reviewed medical records of 192 neonates who were admitted to the NICU of PNUH from March 2006 to March 2007. Surveillance cultures from rectal swabs for detecting VRE were obtained weekly during the study period. We analyzed the prevalence of VRE and various risk factors. RESULTS: The rate of VRE colonization among NICU patients was 25% (48/192). Thirty five of these VRE colonized patients were transferred to the NICU from other local hospitals. Compared with the non-VRE group, the risk factors associated with VRE colonization were lower birth weight, congenital heart disease, applied mechanical ventilation, use of a central venous catheter, chest tubing, a history of surgery, and use of antibiotics. CONCLUSION: VRE colonization among patients admitted to the NICU is rapidly increasing. Monitoring and managing premature neonates from the beginning of the birth process, avoiding many invasive procedures, avoiding antibiotics such as vancomycin and third generation cephalosporin are important for preventing the emergence and spread of VRE colonization in the NICU.

A case of Dubin-Johnson syndrome with a pigmented neurofibroma / 대한내과학회지

Clinically, Dubin-Johnson syndrome is characterized by mild icterus without specific symptoms or signs. The icterus is so mild that it is usually noted only during another illness, pregnancy, or the use of oral contraceptives. There is no pruritus in ubin-Johnson syndrome. The physical examination is usually normal, except for the icterus, although hepatosplenomegaly is seen occasionally. Histologically, the liver is normal, except for the presence of dense pigment making it appear black grossly. Pigmentation of tissues other than the liver in patients with Dubin-Johnson syndrome has been reported only in a few cases. We experienced a case of Dubin-Johnson syndrome with extrahepatic pigmentation in the skin with a neurofibroma in a 66-year-old man.

A Case of Collapsing Glomerulopathy in Renal Allograft / 대한신장학회지

Collapsing glomeruopathy (CG) is a clinicopathologic variant of focal segmental glomerulosclerosis (FSGS) and is characterized by severe nephrotic syndrome, rapid progression to end stage renal disease, and features of visceral epithelial cell injury and glomerular capillary collapse. Such characteristics closely resemble those of HIV associated nephropathy. The frequency of CG has increased over the last decade. The cause of CG is unknown. The lesion has rarely been described in renal allografts with features similar to CG in native kidney. We recently identified allograft CG in a 44 year-old male patient who underwent biopsy for graft dysfunction after autodermic graft. The biopsy showed typical characteristics of CG. Serologically, the patient had no evidence of HIV infection. The renal function was not restored to normal in spite of methylprednisolone pulsing therapy. Now he is on conservative treatment with a functioning graft.

Clinical Observation of Colorectal Polyps / 대한소화기내시경학회지

BACKGROUND/AIMS: The detection and removal of colorectal polyps are important for secondary prevention of colorectal cancer. We investigated the characteristics and histopathologic finding of polyps to better plan their management. METHODS: We analyzed 334 patients who underwent polypectomies for 770 colorectal polyps between October, 2005 and April, 2007 at Bong Seng Memorial Hospital. RESULTS: Colorectal polyps were frequent in the sixth decade in both sexes. The ratio of male to female patients was 1.72:1. Abdominal pain/discomfort was the most common symptom (34.4%), and the most common site of polyp localization was the rectosigmoid colon. Histopathologic examination showed tubular adenomas (54.6%), hyperplastic polyps (36.4%), and inflammatory polyps (5.6%). Adenomatous polyps were more common in patients with multiple polyps than in patients with a single polyp. Adenomatous polyps with villous histology were more common in patients with large polyps than in patients with small polyps. Non-neoplastic polyps were common before the fifth decade. Neoplastic polyps were common past the fifth decade. CONCLUSIONS: In this study, tubular adenomas were frequently found on histopathologic examination, sessile type were frequently found on gross examination, and colorectal polyps were found principally in the rectosigmoid colon. Neoplastic polyps were more frequent in patients beyond the fifth decade. There fore colonoscopy examination is recommended for secondary prevention of colon cancer.

Clinical Manifestations of Pulmonary Sequestration / 소아알레르기및호흡기학회지

PURPOSE: Pulmonary sequestration is characterized by a mass of non-functioning pulmonary tissue lacking normal communication with the tracheobronchial tree and receiving an aberrant systemic arterial blood supply. Two types have been described:intralobar and extralobar. Symptoms vary from the incidental finding of a mass to recurrent bronchitis or pneumonia, chest pain and hemoptysis. In this study, we evaluated clinical features and outcomes of pulmonary sequestration. METHODS: The records of the patients diagnosed with pulmonary sequestration by thoracic computerized tomography and aortography between January 1997 and July 2007 were retrospectively reviewed. RESULTS: Fourteen patients (6 males and 8 females) with an median age of 5.5 years in children, 35 years in adults were diagnosed with pulmonary sequestration. Nine patients had clinical symptoms including recurrent respiratory infections, chest pain and hemoptysis. Six patients were symptom free. The aberrant arteries originated from the descending thoracic aorta in 12 cases, abdominal aorta in 2 cases, inferior phrenic artery in 1 case. Thirteen patients received surgical operations with open thorax in 11 patients and with video-assisted thoracotomy surgery (VATs) in 2 cases recently diagnosed. Eleven cases (84.6%) were found to be of intralobar type and 2 cases (15.4%) were of extralobar type. One patient had bilateral pulmonary sequestration. All patients with preoperative symptoms improved after surgical treatment. CONCLUSION: The patients who presented with recurrent pneumonia in the same site, hemoptysis and chest pain should be studied to rule out pulmonary sequestration.

Correlation between the Diagnostic Validity of Enzymeimmunoassay and the Hyperreactivity of the Respiratory Tract for the Diagnosis of Mycoplasma pneumoniae / 소아알레르기및호흡기학회지

PURPOSE:Mycoplasma pneumoniae (M. pneumoniae) is one of the common causes of lower respiratory tract diseases. Several studies have suggested that respiratory infection by M. pneumoniae may be associated with a reactive airway disease and asthma. In order to find such relationships, we compared the particle agglutination test with enzyme immunoassay (EIA) which were checked on the 1st, and at 1 and 5 or 7 days of follow-up. We also evaluated EIA in association with bronchial hypersensitivity. METHODS:One hundred eleven children who were out patients or hospitalized with pneumonia at Inje University and Hallym University Hospitals were included in the study. Patients were grouped according to the M. pneumoniae antibody titer. Patients who showed initial M. pneumoniae antibody titer and EIA Immunoglobulin (Ig) G/IgM greater than 1:320 were designated as group 1 (n=46). In group 2 (n=33), patients showed initial M. pneumoniae antibody titer lower than 1:320 but it increased more than fourfold between acute and convalescent stages. Group 3 (n=32) was a control group. We measured eosinophil counts, the total IgE, and the eosinophil cationic protein (ECP). Thirty-five children were checked with the methacholine test 3 or 4 months, after the first visit. Bronchial hypersensitiveness was defined positive if the concentration of methacholine was less than the lower limit (8 mg/mL methacholine). RESULTS:All 111 patients participated in the particle agglutination test at the initial and convalescent stages. The sensitivity and specificity for EIA were obtained from the results of the particle agglutination test. The sensitivity and specificity of acute and convalescent EIA IgG were 44.3% and 90.6%, and 67.1% and 96.9%, respectively. The sensitivity and specificity of acute and convalescent EIA IgM were 60.8% and 100%, and 92.4% and 100%, respectively. The M. pneumoniae antibody titer was associated with hospitalized days and improvement of chest X-rays. Only in group 3, the M. pneumoniae antibody titer correlated with the ECP level, but there was no significant difference between the methacholine test and eosinophil counts. CONCLUSION:The results of this study suggest that EIA may be a useful diagnostic method for detecting early phase of M. pneumoniae infection.

A Case ofEscherichia Coli Empyema Preceded by Gastroenteritis / 소아알레르기및호흡기학회지

Pleural empyema is characterized by presence of pus or microorganism in the pleural fluid. Most cases of empyema in children are caused by bacterial pneumonia, and the most common pathogen is Staphylococcus areus or Streptococcus pneumoniae. But other uncommon causes of empyema include esophageal rupture, mediastinal disease, tumors, sepsis, thoracic trauma, and surgery can be produced by various pathogens. We experienced a case of Escherichia coli empyema followed by gastroenteritis in 9-year-old boy.

Clinical Significance of Follow-up CT after Ultrasonographyfor Acute Appendicitis in Children / 대한소아소화기영양학회지

PURPOSE: The ultrasonography (USG) and computed tomography (CT) are popular diagnostic tools for the diagnosis of acute appendicitis in children, but there are many debates about their clinical significance. The purpose of this study is to clarify the clinical significance of USG, CT and follow-up CT performed subsequently to USG, especially in perforated acute appendicitis in children. METHODS: We have reviewed 419 cases of surgically confirmed acute appendicitis in children under the age of sixteen, who had been treated in Inje University Ilsan Paik Hospital from March 2002 to February 2006. All the clinical data including the results of USG and CT were collected and analyzed. RESULTS: Sensitivity, specificity, positive and negative predictive values of USG were 98.7%, 96.8%, 98.1%, 97.8% in non-perforation group and 90.8%, 100%, 100%, 81.9% in perforation group. Those of CT were 96.4%, 100%, 100%, 96.5% and 86.6%, 100%, 100%, 87.5% respectively. Those of follow-up CT after USG were 100%, 100%, 100%, 100% and 87.5%, 100%, 100%, 92.0% respectively. The duration of using antibiotics in seven patients showed positive correlation with the interval between two imaging studies (r=0.0472, p=0.019). There was no statistical significance of correlation when these imaging studies performed within 30 hours together. CONCLUSION: In most of the cases, single choice between USG and CT would be enough to diagnose the acute appendicitis in children. But, it may be helpful to perform CT as early as possible subsequently to USG when there is discrepancy between initial USG and clinical impression.

The effectiveness of urokinase in treatment of pleural effusion in children / 소아과

PURPOSE: Pleural effusion is a common complications of pediatric bacterial pneumonia. Intrapleural administration of fibrinolytic agents such as urokinase have been used in the management of complicated parapneumonic effusions. But the safety and effectiveness of intrapleural urokinase instillations in children has not been confirmed. The aim of this study is to evaluate the safety and effectiveness of intraperitoneal urokinase in children. METHODS: We reviewed a total of 29 children diagnosed as parapneumonic effusion with septation by chest CT or chest ultrasonography. We divided them into two groups. Fourteen children treated with urokinase after thoracostomy (Group A) were compared with 15 children treated only with thoracostomy (Group B). The urokinase, 3,000 IU/kg/day, was injected into the pleural cavity twice a day. RESULTS: There was no statistical difference in sex and age between the two groups. Total drainage volume during thoracostomy in group A and B was 375.5 mL and 350.0 mL, respectively. It was not statistically significant. But the amounts of pleural fluid of group A on day 1, day 2 and day 3 were 102.5 mL, 100.0 mL, and 70.0 mL respectively and those of group B on day 1, day 2 and say 3 were 120.0 mL, 50.0 mL and 15.0 mL respectively. To compare group A with group B in the amounts of drainage volume on day 1 was not statistically significant, but the amounts of drainage volumes on day 2 and day 3 in group A were statistically more significant than group B (Day 1 P=0.371, Day 2 P=0.049, Day 3 P=0.048, respectively). The duration of fever, antibiotics, thoracostomy and total hospital days. Were not statistically significant between the two groups. But the frequency of complications in Group A was statictically significantly lower than in group B. CONCLUSION: Intrapleural instillation of urokinase facilitates the drainage of loculated pleural effusions, especially during the first 3 days, and it could reduce complications, such as pleural thickening, surgical managements, re-positioning of tube and re-thoracostomy. So intrapleural urokinase injection was and effective and safe treatment of pleural effusion in children (P=0.014).

Risk of the Metabolic Syndrome according to the Level of the Uric Acid

BACKGROUND: Many epidemiological studies have reported that hyperuricemia was related to cardiovascular diseases, insulin resistance and the metabolic syndrome. However, there are few studies on the relationship between serum uric acid concentration and the metabolic syndrome among Korean adults. We performed this study to assess the relationship between serum uric acid level and the factors of the metabolic syndrome among healthy Korean men. METHODS: We consecutively selected 206 male subjects who underwent health screening examination from February 2005 to April 2005 at the Health Promotion Center of Seoul Paik Hospital. Insulin resistance measured by HOMA-IR and the metabolic syndrome factors were assessed by the quartiles of serum uric acid level. RESULTS: Body mass index (P<0.001), systolic blood pressure (P=0.015), diastolic blood pressure (P=0.015), fasting insulin (P=0.038), and triglyceride (P=0.005) level increased and high density lipoprotein cholesterol (P=0.008) decreased significantly from the lowest quartile to the highest quartile of seum uric acid level. The proportions of the metabolic syndrome in each quartile were 13.7%, 15.7%, 18.9%, and 36.0%, respectively (P=0.007). However, insulin resistance measured by HOMA-IR was not associated with serum uric acid. When compared with the lowest quartile group, the odds ratio for the metabolic syndrome of the second, the third, and the highest quartile groups were 1.42 (0.39-5.14), 1.14 (0.33-3.92), and 4.00 (1.15-13.89), respectively. CONCLUSION: We found that high uric acid level was significantly related to the factors of the metabolic syndrome and increased the risk of the metabolic syndrome. Further prospective studies with large sample size are necessary to establish whether uric acid level can pose as a risk factor for the development of the metabolic syndrome.