Investigation of theoretical maximum water yield and efficiency-optimized temperature for cyclopentane hydrate-based desalination.

Hydrate-based desalination (HBD) shows promise as a freshwater production technology for saline water. Liquid-phase hydrate formers, with their ability to facilitate hydrate formation at atmospheric pressure, have gained attention for their high energy efficiency in HBD. This study explored cyclopentane (CP) HBD by experimentally measuring the thermodynamic properties of CP hydrate in saline solutions and developing a theoretical framework to estimate the water yield of CP HBD under various operating conditions. The measured dissociation enthalpy of CP hydrate was found to be 12 % and 22 % lower compared to those of propane and R134a hydrates, respectively. The equilibrium dissociation temperatures of CP hydrate at different NaCl concentrations under atmospheric pressure were experimentally measured and then predicted using the Hu-Lee-Sum correlation. The theoretically achievable maximum salinity and water yield for CP HBD were calculated in the temperature range of 268-280 K and the initial salinity range of 0-8 wt.%. Additionally, the concept of HBD heat efficiency, representing the maximum amount of pure water producible per unit of heat, was introduced to identify an optimal operating condition for the HBD process. Efficiency-maximized temperatures, where the HBD heat efficiency reached its peaks, were determined for various initial salinities in the process, for example, 273.4 K for NaCl 3.5 wt.% solution. This novel approach provides invaluable guidance for determining the most energy-efficient operating conditions in the HBD process and establishes a solid foundation for further advancements in this field.

Real-World Epidemiology, Treatment Patterns, and Disease Burden of Chronic Hepatitis B and HDV Co-Infection in South Korea.

INTRODUCTION: Long-term complications of chronic hepatitis B (CHB) viral infection, such as cirrhosis, hepatocellular carcinoma (HCC), and liver failure, cause a large disease burden. This study aimed to describe the epidemiology, clinical outcomes, and treatment patterns of CHB infection and co-infection with hepatitis D virus (HDV) in South Korea. METHODS: The retrospective, observational study used existing data from the Health Insurance Review and Assessment Service (HIRA) database. Confirmed cases of (CHB) and HBV/HDV co-infection were identified between 2013 and 2019. Hepatitis C virus co-infections and acute HBV infections were excluded. Incident cases diagnosed between 2015 and 2018 with no prior disease history up to 2 years were included. Patient characteristics, clinical outcomes, economic burden, and healthcare-resource utilization were described. RESULTS: The estimated 7-year prevalence of CHB and HBV/HDV co-infection were 0.9% and 0.0024%, respectively. The prevalence was higher among 45-54 years old (CHB: 1.6%, HBV/HDV: 0.0049%) and males (1.1%, 0.0035%). The 5-year cumulative incidences of compensated cirrhosis, decompensated cirrhosis, HCC, and liver transplantation were 13.3%, 7.1%, 8.4%, and 0.7%, respectively. Hyperlipidemia (40.6%), hypertension (23.5%), and peptic ulcer (23.7%) were the more prevalent comorbidities. Among CHB patients, 48.1% received ≥ 1 prescribed anti-HBV drug including interferon or nucleos(t)ide analogues and 64.4% had ≥ 1 hospitalization compared to 80.4% and 79.4% HBV/HDV patients. Estimated total healthcare costs for CHB and HBV/HDV were US$786 million and $62 million, respectively. CONCLUSIONS: These findings provide insights to the epidemiology, clinical burden, treatment patterns, and healthcare costs of CHB and HBV/HDV co-infection in South Korea.

Reactive Halogen Species-Mediated Electrocatalytic Oxidation of Arsenite(III).

Electrocatalytic advanced oxidation processes have long been considered among of the most viable ways to remediate aquatic contaminants, including As(III). Although direct electrochemical oxidation of As(III) is thermochemically facile, a high reaction rate is not easily achieved because of the competitive oxygen evolution reaction (OER), particularly at high potentials. This study examines the effect of three halides (Cl-, Br-, and I-) on the electrochemical oxidation of As(III) with nanoparticulate TiO2 electrodes in an aqueous bicarbonate solution at pH 8.7. The halides significantly enhance As(III) oxidation kinetics by >4, >8, and >20 times, respectively, under optimal conditions. Faradaic efficiencies of As(V) production (AsV-FEs) are also enhanced by a maximum of 10 times by the halides, even at high potentials at which the OER occurs. Pre-electrolysis of each halide solution produces reactive halogen species (ClO-, BrO-, and I3-). As(III)-spiking of the pre-electrolyzed halide solutions allows simultaneous concentration changes at near-stoichiometric ratios (R2 > 0.98) between each halogen species and As(V). Among the three halides, iodide imparts the strongest effect on As(III) oxidation owing to its lowest redox potential. Finally, technical considerations of reactive-halogen-species-mediated As(III) oxidation are discussed.

The impact of the abnormal salinity enrichment in pore water on the thermodynamic stability of marine natural gas hydrates in the Arctic region.

In this study, the thermodynamic and structural characteristics of natural gas hydrates (NGHs) retrieved from gas hydrate mounds (ARAON Mound 03 (AM03) and ARAON Mound 06 (AM06)) in the Chukchi Sea in the Arctic region were investigated. The gas compositions, crystalline structure, and cage occupancy of the NGHs at AM03 and AM06 were experimentally measured using gas chromatography (GC), 13C nuclear magnetic resonance (NMR), Raman spectroscopy, and powder X-ray diffraction (PXRD). In the NGHs from AM03 and AM06, a significantly large fraction of CH4 (> 99%) and a very small amount of H2S were enclathrated in small (512) and large (51262) cages of sI hydrate. The NGHs from AM03 and AM06 were almost identical in composition, guest distributions, and existing environment to each other. The salinity of the residual pore water in the hydrate-bearing sediment (AM06) was measured to be 50.32‰, which was much higher than that of seawater (34.88‰). This abnormal salinity enrichment in the pore water of the low-permeability sediment might induce the dissociation of NGHs at a lower temperature than expected. The saturation changes in the NGHs that corresponded with an increase in the seawater temperature were also predicted on the basis of the salinity changes in the pore water. The experimental and predicted results of this study would be helpful for understanding the thermodynamic stability of NGHs and potential CH4-releasing phenomena in the Arctic region.

Thermodynamic and structural features of chlorodifluoromethane (a sI-sII dual hydrate former) + external guest (N2 or CH4) hydrates and their significance for greenhouse gas separation.

In this study, a new sI-sII dual hydrate former [chlorodifluoromethane (CHClF2); an important greenhouse gas with a global warming potential of 1810], which forms sI hydrate by itself and forms sII hydrate in the presence of external help guests such as CH4 and N2, was introduced and closely investigated for its potential significance in gas hydrate-based gas separation. The phase equilibria of CHClF2 hydrate, binary CHClF2 (5%) + N2 (95%) hydrate, and binary CHClF2 (5%) + CH4 (95%) hydrate were measured to examine the formation conditions and thermodynamic stability regions of CHClF2 + external guest hydrates. Nuclear magnetic resonance and in situ Raman spectroscopic results confirmed the formation of sII hydrates for CHClF2 + external guest (N2 or CH4) mixtures. Powder X-ray diffraction patterns clearly demonstrated a structural transition of sI to sII hydrates and a preferential incorporation of CHClF2 molecules in the hydrate phase when external guests (N2 or CH4) were involved in CHClF2 hydrate formation. The measured dissociation enthalpy values of CHClF2 hydrate, binary CHClF2 (5%) + N2 (95%) hydrate, and binary CHClF2 (5%) + CH4 (95%) hydrate using a high-pressure micro-differential scanning calorimeter also indicated preferential CHClF2 enclathration. The experimental results provide new insights into the thermodynamic and structural features of the CHClF2 (sI-sII dual hydrate former) + external guest hydrates for understanding and designing the hydrate-based CHClF2 separation process.

Evaluation of kinetic salt-enrichment behavior and separation performance of HFC-152a hydrate-based desalination using an experimental measurement and a thermodynamic correlation.

Hydrate-based desalination (HBD), a type of freezing-based desalination, can concentrate salts of saline water and produce fresh water via hydrate crystal formation. In this study, the thermodynamic stability, crystallographic information, and kinetic growth behavior of HFC-152a hydrate were investigated to estimate the desalination efficiency of HBD. The phase equilibria revealed that the HFC-152a hydrate could be formed at a higher temperature in the presence of NaCl (0 wt%, 3.5 wt%, and 8.0 wt%) than the HFC-134a hydrate at 0.3 MPa. The hydration number of the HFC-152a hydrate (sI) was found to be 7.74 through the Rietveld refinement of the powder X-ray diffraction patterns, and it was also used to determine the dissociation enthalpy of the HFC-152a hydrate. The Hu-Lee-Sum correlation was employed to predict the equilibrium shift and hydrate depression temperature of both HFC-152a and HFC-134a hydrates in the presence of NaCl. Faster hydrate growth kinetics and higher hydrate conversion were observed for the HFC-152a hydrate in saline solutions despite the smaller initial driving force at 0.3 MPa and the subcooling temperature of 3 K. Additionally, to quantify the desalination efficiency of the HFC-152a HBD, the maximum achievable salinity and maximum water yield were examined using the HLS correlation. The salt-enrichment efficiency decreased with an increase in the initial salinity and increased with increasing the subcooling. The overall results indicate that HFC-152a is, potentially, a superior candidate for HBD. The novel approach examined in this study will be useful for assessing the desalination efficiency of the HBD process.

Influence of Competitive Inclusion of CO2 and N2 on sII Hydrate-Flue Gas Replacement for Energy Recovery and CO2 Sequestration.

This study investigated the structural transformation, guest distributions, and the extent of replacement in CH4 + C3H8-flue gas replacement occurring in sII hydrates via gas chromatography, NMR spectroscopy, and powder X-ray diffraction (PXRD). Simulated flue gas (CO2 (20%) + N2 (80%)) was injected into an sII CH4 (90%) + C3H8 (10%) hydrate for guest exchange. The extent of replacement occurring in CH4 + C3H8-flue gas replacement was much lower than that of CH4 + C3H8-CO2 replacement. Furthermore, 13C NMR spectra and PXRD patterns revealed that unlike CH4 + C3H8-CO2 replacement, CH4 + C3H8-flue gas replacement did not undergo any structural transformation during the replacement (i.e., iso-structural replacement in the sII hydrate). Rietveld refinement of PXRD patterns of gas hydrates after replacement using flue gas injection demonstrated that CO2 molecules occupied both the small (512) and large (51264) cages, whereas N2 molecules occupied only the small (512) cages. CO2 and N2 were not complementary but competitive in replacing CH4 in the small (512) cages, which contributed to the maintenance of the cage stability of the initial sII hydrate and thus, resulted in a lower extent of replacement. The experimental results obtained in this study provide valuable insights on the accurate replacement mechanism and cage-specific guest exchange behavior of sII hydrates using flue gas injection for energy recovery and CO2 sequestration.

Effects of transcranial direct current stimulation using miniaturized devices vs sertraline for depression in Korea: A 6 week, multicenter, randomized, double blind, active-controlled study.

We compared the efficacy and safety of transcranial direct current stimulation (tDCS) vs. Sertraline in the treatment of Major Depressive Disorder (MDD) in South Korean participants. This was a multi-center, double blind, active controlled study with non-inferiority testing. Patients were randomly assigned to receive tDCS (n = 45) or Sertraline (n = 47). tDCS was administered in 30-min, 2 mA prefrontal stimulation sessions for 10 consecutive weekdays, followed by 2 treatments at 4 and 6 weeks. Sertraline was administered at a dose of 50 mg per day for 6 weeks. The primary outcome measure was a change in the Montgomery-Asberg Depression Rating Scale (MADRS) score at six weeks. Mean MADRS scores decreased by 14.58 ± 8.51 points in the tDCS group and 12.32 ± 8.56 points in the Sertraline group. There was no significant main effect of group (p = 0.5877) or time by group interaction across weeks 0, 3, and 6 (p = 0.1539). Noninferiority of tDCS compared with Sertraline was not demonstrated. The mean difference between the Sertraline and tDCS group was -2.258 (95% confidence interval [CI], -5.795 to 1.27811), and the lower boundary of the CI was lower than the prespecified noninferiority margin of -3.56. There were no significant group differences in the rate of adverse events. In the present study, the noninferiority of tDCS to Sertraline for the treatment of depression was not found in this Korean population.

Effect of drug compliance on health care costs in newly-diagnosed dementia: Analysis of nationwide population-based data.

BACKGROUND: The cost-effectiveness of both cholinesterase inhibitors and memantine by delaying nursing home placement has been supported by numerous studies. The importance of sustained pharmacological treatment in dementia has been relatively less recognized by public health policies compared to early diagnosis. We investigated the effect of the drug (donepezil, rivastigmine, galantamine, and memantine) compliance on the health care costs in newly-diagnosed dementia. METHODS: National Health Insurance Service (NHIS) database which covers the entire population of South Korea was used for analysis. Health care expenditure of patients newly-diagnosed with dementia in between 2012 and 2014 was investigated for 3-5 years. For drug compliance, we used Medication Possession Ratio (MPR) that indicates the percentage of time a patient has access to medication. Multivariate linear regression analysis including generalized estimated equation and gamma distribution was used for statistical analysis. RESULTS: We identified 252,594 patients who were both prescribed with cognitive enhancers and newly diagnosed with dementia. When initial MPR increased 20%, total health care costs decreased 8.4% (RR = 0.916, 95%; CI 0.914 to 0.916). Same relationship was shown with medical costs related to dementia, admission to a general hospital, and emergency room visits. When MPR increased 20% compared to the previous year, the total health care costs, admission to a general hospital, emergency room visits, and admission to a nursing hospital decreased. CONCLUSIONS: This population-based retrospective cohort study provides evidence that patients newly-diagnosed with dementia who showed higher initial drug compliance or maintained antidementia drugs (Cholinesterase inhibitors and memantine) would benefit in total health-care costs.

Transient Blindness in a Patient with Severe Metformin-Associated Lactic Acidosis (MALA).

A 68-year-old man presented at the emergency room with sudden blindness. The day before, he had eaten sashimi and eel and drank alcohol for dinner. He experienced nausea, vomiting, and dizziness afterward. His medical history included hypertension and diabetes, and the latter was treated with metformin. Initial laboratory tests revealed severe metabolic acidosis (lactic acidosis). Massive hydration and intravenous sodium bicarbonate replacement therapies were initiated, but severe metabolic acidosis (lactic acidosis) did not resolve, in turn, leading to hemodialysis, which decreased metabolic acidosis. The patient's blindness improved, and his vision gradually recovered. As it is not easy to distinguish between blindness related to metformin-associated lactic acidosis (MALA) and blindness related to other causes, rapid correction of metabolic acidosis through hemodialysis might be helpful in differentiating this from of blindness from blindness related to other causes.

Associated risk factors for psychological distress in patients with gastric epithelial neoplasm undergoing endoscopic submucosal dissection.

This study aimed to evaluate the psychological distress and associated risk factors for distress among patients with gastric epithelial neoplasm undergoing endoscopic submucosal dissection (ESD).A total of 91 patients treated with ESD for gastric epithelial neoplasm between May 2015 and June 2016 were prospectively enrolled. Sociodemographic factors, psychological distress, anxiety, depression, stress, and associated risk factors for psychological distress were evaluated the day before ESD.Twenty-six (28.6%) patients were identified as patients with psychological distress. The psychological distress group had a higher female ratio and more depression and anxiety symptoms than the non-distress group. Distress was also related to stress level. A multivariate analysis showed that unmarried status (odds ratio [OR], 4.94; 95% confidence interval [CI], 1.13-21.56, P = .034), anxiety (OR, 1.24; 95% CI, 1.12-1.39, P <.001), and stress (OR, 1.06; 95% CI, 1.01-1.12, P = .011) were associated with psychological distress.An unmarried status and a high level of anxiety and stress were associated with more psychological distress in patients undergoing gastric ESD. It could be helpful to screen and proactively monitor patients with such conditions before performing gastric ESD.

The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study.

BACKGROUND: Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient's clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown. METHODS: The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation. RESULTS: There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor's mental health, was significantly reduced and pain tended to decrease. CONCLUSIONS: Increasing the physician's awareness of the patient's mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.

Comparing the Effectiveness and Safety of the Addition of and Switching to Aripiprazole for Resolving Antipsychotic-Induced Hyperprolactinemia: A Multicenter, Open-Label, Prospective Study.

OBJECTIVES: Hyperprolactinemia is an important but often overlooked adverse effect of antipsychotics. Several studies have shown that switching to or adding aripiprazole normalizes antipsychotic-induced hyperprolactinemia. However, no study has directly compared the effectiveness and safety of the 2 strategies. METHODS: A total of 52 patients with antipsychotic-induced hyperprolactinemia were recruited. Aripiprazole was administered to patients with mild hyperprolactinemia (serum prolactin level < 50 ng/mL). Patients with severe hyperprolactinemia (serum prolactin level > 50 ng/mL) were randomized to an aripiprazole-addition group (adding aripiprazole to previous antipsychotics) or a switching group (switching previous antipsychotics to aripiprazole). Serum prolactin level, menstrual disturbances, sexual dysfunction, psychopathologies, and quality of life were measured at weeks 0, 1, 2, 4, 6, and 8. RESULTS: Both the addition and switching groups showed significantly reduced serum prolactin level and menstrual disturbances and improved sexual dysfunction. In patients with severe hyperprolactinemia, the numbers of patients with hyperprolactinemia and menstrual disturbance in the switching group were significantly lower than those in the addition group at week 8. CONCLUSIONS: Both the addition and switching strategies were effective in resolving antipsychotic-induced hyperprolactinemia and hyperprolactinemia-related adverse events, including menstrual disturbances and sexual dysfunction. In addition, these findings suggest that switching to aripiprazole may be more effective than addition of aripiprazole for normalizing hyperprolactinemia and improving hyperprolactinemia-related adverse events in patients with schizophrenia.

Incidence and risk factors for psychiatric comorbidity among people newly diagnosed with cancer based on Korean national registry data.

OBJECTIVE: The present study investigates the incidence of psychiatric disorders, related risk factors, and the use of mental health services among people newly diagnosed with one of five major cancers (stomach, liver, colorectal, lung, and breast cancer) based on national registry data from the National Health Insurance Service (NHIS) in the Korean population. METHODS: We collected data on people newly diagnosed with one of the five major cancers between 2005 and 2008 using the nationwide claims data and cancer registration files of the NHIS. We analyzed the data of those diagnosed with psychiatric disorders over a 5-year period, from 2004 to 2009. RESULTS: Among 302,844 people with newly diagnosed cancer, we identified 31,579 patients (10.43%) who were also newly diagnosed with psychiatric disorders after their cancer diagnosis. Among psychiatric diagnoses, anxiety disorders and depression showed the highest incidences of 18.13 and 13.16 per 1000 person-years, respectively. Among major cancers, patients with lung cancer showed the highest incidence of psychiatric disorders. Older age and female gender were shown to be risk factors associated with psychiatric comorbidity, and no significant differences were found for region of residence. CONCLUSION: The present study showed a low incidence of psychiatric comorbidity and suggests that psychiatric disorders in cancer patients tend to be underrecognized in actual clinical practice. Greater risk for psychiatric comorbidity was associated with lung cancer, older age, and female gender. The present findings provide important information for establishing national policies to detect and manage mental health problems during cancer care.

The relationship between parental marital status and suicidal ideation and attempts by gender in adolescents: results from a nationally representative Korean sample.

OBJECTIVE: Suicide in adolescents is a major problem worldwide. The purpose of this study was to identify differences in suicidal behaviors with respect to parental marital status. METHODS: The data used in this study were obtained from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) of middle and high school students in 2010. Using a national representative sample, this study analyzed data from 73,238 subjects. With respect to gender, the odds ratios of suicidal behavior were calculated based on the parental marital status, living situation, and family affluence scale (FAS). RESULTS: After adjusting for age, achievement, sadness, and substance use, the prevalence of suicidal ideation in adolescents with a remarried parent significantly increased among boys to 1.364 [95% confidence interval (CI)=1.027-1.813] and among girls to 1.511 (95% CI=1.215-1.879). The odds ratio of suicide attempts increased to 1.808 (95% CI=1.119-2.923) for adolescent boys and to 1.947 (95% CI=1.609-2.356) for adolescent girls. However, having a single parent did not affect the prevalence of suicidal ideation in either gender. In girls, as family affluence decreased, the odds ratio of suicidal ideation notably increased. For girls whose families were in a low tier of the FAS, the odds ratio of both suicidal ideation and suicide attempts increased. CONCLUSIONS: Both boys and girls were more likely to report suicidal ideation and attempts after a parent's remarriage, whereas family affluence was inversely related to suicidal ideation and attempts in girls.

Assessment of implicit self-esteem in bipolar manic and euthymic patients using the implicit association test.

OBJECTIVE: Although self-esteem is thought to be an important psychological factor in bipolar disorder, little is known about implicit and explicit self-esteem in manic patients. In this study, we investigated differences in implicit and explicit self-esteem among bipolar manic patients, bipolar euthymic patients, and healthy controls using the Implicit Association Test (IAT). METHODS: Participants included 19 manic patients, 27 euthymic patients, and 27 healthy controls. Participants completed a self-esteem scale to evaluate explicit self-esteem and performed the self-esteem IAT to evaluate implicit self-esteem. RESULTS: There were no differences among groups in explicit self-esteem. However, there were significant differences among groups in implicit self-esteem. Manic patients had higher IAT scores than euthymic patients and a trend toward higher IAT scores than healthy controls. CONCLUSIONS: Our findings suggest that, on the latent level, a manic state is not simply the opposite of a depressed state. Furthermore, there may be a discontinuity of implicit self-esteem between manic and euthymic states. These unexpected results may be due to characteristics of the study participants or the methods used to assess implicit self-esteem. Nevertheless, they provide greater insights on the psychological status of manic patients.

Association between total sleep duration and suicidal ideation among the Korean general adult population.

STUDY OBJECTIVES: Examine the association between sleep duration and suicidal ideation in Korean adults. DESIGN: Cross-sectional survey. SETTING: Data obtained by the Korea National Health and Nutrition Examination Survey IV (2007-2009) using a rolling sampling design involving a complex, stratified, multistage, and probability-cluster survey of civilian non-institutionalized Korean residents. PARTICIPANTS: A total of 15,236 subjects (6,638 males and 8,598 females) ≥ 19 years old. MEASUREMENTS AND RESULTS: The weighted prevalence of self-reported short sleep duration (≤ 5 h/day) was 11.7% in males and 15% in females, and of long sleep duration (≥ 9 h/day) was 6.7% in males and 8.9% in females. A U-shaped relationship existed, with both short and long sleep durations associated with a higher suicidal ideation risk. Multiple logistic regression analysis was used to analyze the relationship between sleep duration and suicidal ideation, adjusting for sociodemographic factors, health behavior, and health status. After controlling for covariates, people with short sleep were 38.1% more likely to have suicidal ideation (OR = 1.381, 95% CI 1.156-1.650) than people with sleep duration of 7 h/day. Suicidal ideation was 1.196 times higher (95% CI: 0.950-1.507) in long-sleeping people than people sleeping 7 h/day, although statistically not significant. Inclusion of depressive mood (a potential confounder) in multiple logistic regression models attenuated but did not eliminate the sleep duration/suicidal ideation association. LIMITATIONS: Sleep duration and suicidal ideation were assessed only by self-report. CONCLUSIONS: The sleep duration/suicidal ideation relationship is U-shaped in the Korean adult population. Self-reported habitual sleep duration may be a useful behavioral indicator for both individual and societal suicidal ideation risk.

Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium.

BACKGROUND: Most previous studies on the efficacy of antipsychotic medication for the treatment of delirium have reported that there is no significant difference between typical and atypical antipsychotic medications. It is known, however, that older age might be a predictor of poor response to antipsychotics in the treatment of delirium. The objective of this study was to compare the efficacy and safety of haloperidol versus three atypical antipsychotic medications (risperidone, olanzapine, and quetiapine) for the treatment of delirium with consideration of patient age. METHODS: This study was a 6-day, prospective, comparative clinical observational study of haloperidol versus atypical antipsychotic medications (risperidone, olanzapine, and quetiapine) in patients with delirium at a tertiary level hospital. The subjects were referred to the consultation-liaison psychiatric service for management of delirium and were screened before enrollment in this study. A total of 80 subjects were assigned to receive either haloperidol (N = 23), risperidone (N = 21), olanzapine (N = 18), or quetiapine (N = 18). The efficacy was evaluated using the Korean version of the Delirium Rating Scale-Revised-98 (DRS-K) and the Korean version of the Mini Mental Status Examination (K-MMSE). The safety was evaluated by the Udvalg Kliniske Undersogelser side effect rating scale. RESULTS: There were no significant differences in mean DRS-K severity or K-MMSE scores among the four groups at baseline. In all groups, the DRS-K severity score decreased and the K-MMSE score increased significantly over the study period. However, there were no significant differences in the improvement of DRS-K or K-MMSE scores among the four groups. Similarly, cognitive and non-cognitive subscale DRS-K scores decreased regardless of the treatment group. The treatment response rate was lower in patients over 75 years old than in patients under 75 years old. Particularly, the response rate to olanzapine was poorer in the older age group. Fifteen subjects experienced a few adverse events, but there were no significant differences in adverse event profiles among the four groups. CONCLUSIONS: Haloperidol, risperidone, olanzapine, and quetiapine were equally efficacious and safe in the treatment of delirium. However, age is a factor that needs to be considered when making a choice of antipsychotic medication for the treatment of delirium. TRIAL REGISTRATION: Clinical Research Information Service, Republic of Korea, (http://cris.nih.go.kr/cris/en/search/basic_search.jsp, Registered Trial No. KCT0000632).

Relationship between negative mental adjustment to cancer and distress in thyroid cancer patients.

PURPOSE: Previous studies have reported that over a third of cancer patients experience significant psychological distress with diagnosis and treatment of cancer. Mental adjustment to cancer as well as other biologic and demographic factors may be associated with their distress. We investigated the relationship between mental adjustment and distress in patients with thyroid cancer prior to thyroidectomy. MATERIALS AND METHODS: One hundred and fifty-two thyroid cancer patients were included in the final analysis. After global distress levels were screened with a distress thermometer, patients were evaluated concerning mental adjustment to cancer, as well as demographic and cancer-related characteristics. A thyroid function test was also performed. Regression analysis was performed to discern significant factors associated with distress in thyroid cancer patients. RESULTS: Our regression model was significant and explained 38.5% of the total variance in distress of this patient group. Anxious-preoccupation and helpless-hopeless factors on the mental adjustment to cancer scale were significantly associated with distress in thyroid cancer patients. CONCLUSION: Negative emotional response to cancer diagnosis may be associated with distress in thyroid cancer patients awaiting thyroidectomy. Screening of mental coping strategies at the beginning of cancer treatment may predict psychological distress in cancer patients. Further studies on the efficacy of psychiatric intervention during cancer treatment may be needed for patients showing maladaptive psychological responses to cancer.

Endoscopic cryotherapy of lung and bronchial tumors: a systematic review.

BACKGROUND/AIMS: We made a systematic review and evaluation of endoscopic cryotherapy of endobronchial tumors, investigating safety and efficacy. METHODS: Qualified studies regarding endoscopic cryotherapy of lung tumors were systemically evaluated using available databases according to predefined criteria. RESULTS: In total, 16 publications were included in the final assessment. A narrative synthesis was performed because a formal meta-analysis was not viable due to the lack of controlled studies and study heterogeneity. Overall success rates for significant recanalization of the obstruction were approximately 80%, although they varied, depending on disease status in the patient population. Complications from the procedure developed in 0-11.1% of cases, most of which were minor and controlled by conservative management. Although limited data were available on comprehensive functional assessment, some studies showed that respiratory symptoms, pulmonary function tests, and performance status were significantly improved. CONCLUSIONS: Endoscopic cryotherapy was found to be a safe and useful procedure in the management of endobronchial tumors although its efficacy and appropriate indications have yet to be determined in well-designed controlled studies.