Pilot study for the Psychometric Validation of the Sheffield Profile for Assessment and Referral to Care (SPARC) in Korean Cancer Patients / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening palliative care needs among Korean cancer patients. @*Materials and Methods@#The English version of the SPARC was translated by four Korean oncologists and reconciled by a Korean language specialist and a medical oncologist fluent in English. After the first version of the Korean SPARC (K-SPARC) was developed, back-translation into English was performed by a professional translator and bilingual oncologist. The back-translated version was reviewed by the original author (S.H.A.), and modifications were made (ver. 2). The second version of the K-SPARC was tested against other questionnaires, including the Functional Assessment of Cancer Therapy-General (FACT-G) and the Edmonton Symptom Assessment System (ESAS). @*Results@#Thirty patients were enrolled in the pilot trial. Fifteen were male, and the median age was 64.5 years. Six patients had an Eastern Cooperative Oncology Group performance status of 2 or more. All patients except one were receiving chemotherapy. Regarding internal consistency, the Cronbach’s α scores for physical symptoms, psychological issues, religious and spiritual issues, independency and activity, family and social issues, and treatment issues were 0.812, 0.804, 0.589, 0.843, 0.754, and 0.822, respectively. The correlation coefficients between the SPARC and FACT-G were 0.479 (p=0.007) for the physical domain and –0.130 (p=0.493) for the social domain. @*Conclusion@#This pilot study indicates that the K-SPARC could be a reliable tool to screen for palliative care needs among Korean cancer patients. A further study to validate our findings is ongoing.

Gender difference in socioeconomic factors affecting suicidal ideation and suicidal attempts among community-dwelling elderly: based on the Korea Community Health Survey / 한국역학회지

OBJECTIVES@#This study was performed to explore socioeconomic factors associated with suicidal ideation and suicidal attempts among the local community’s resident elderly. @*METHODS@#The subjects included 129,277 participants aged 65 years or above of the Korea Community Health Survey conducted in 2013 and 2017. Based on the questions for suicidal ideation and suicidal attempts, the subjects were divided into a no suicidal ideation group (n=111,344), a suicidal ideation group (n=17,487), and a suicidal attempt group (n=446). All analyses were stratified by gender, and a complex sample logistic regression analysis was performed to analyze associated factors. SAS version 9.4 was used for all analyses with a significance level of 0.05. @*RESULTS@#Common factors associated with suicidal ideation in both genders included marital status, frequency of contact with friends, social activity, and average monthly household income. Economic activity was demonstrated as relevant only to the elderly men subjects. According to the analysis, factors associated with suicidal attempts were the recipients of the National Basic Living Security Act for the elderly men compared to age, frequency of contact with family, frequency of contact with friends, and average monthly household income for the elderly women. @*CONCLUSIONS@#The study revealed that socioeconomic factors leading to suicidal ideation were similar in the elderly of both genders, while a difference was demonstrated for factors associated with suicidal attempts between the elderly of both genders. It is expected that the results of this study may be used as the basis for screening the local community’s elderly with a high suicidal risk, and in the development of suicide prevention services.

Gender difference in socioeconomic factors affecting suicidal ideation and suicidal attempts among community-dwelling elderly: based on the Korea Community Health Survey / 한국역학회지

OBJECTIVES@#This study was performed to explore socioeconomic factors associated with suicidal ideation and suicidal attempts among the local community’s resident elderly. @*METHODS@#The subjects included 129,277 participants aged 65 years or above of the Korea Community Health Survey conducted in 2013 and 2017. Based on the questions for suicidal ideation and suicidal attempts, the subjects were divided into a no suicidal ideation group (n=111,344), a suicidal ideation group (n=17,487), and a suicidal attempt group (n=446). All analyses were stratified by gender, and a complex sample logistic regression analysis was performed to analyze associated factors. SAS version 9.4 was used for all analyses with a significance level of 0.05. @*RESULTS@#Common factors associated with suicidal ideation in both genders included marital status, frequency of contact with friends, social activity, and average monthly household income. Economic activity was demonstrated as relevant only to the elderly men subjects. According to the analysis, factors associated with suicidal attempts were the recipients of the National Basic Living Security Act for the elderly men compared to age, frequency of contact with family, frequency of contact with friends, and average monthly household income for the elderly women. @*CONCLUSIONS@#The study revealed that socioeconomic factors leading to suicidal ideation were similar in the elderly of both genders, while a difference was demonstrated for factors associated with suicidal attempts between the elderly of both genders. It is expected that the results of this study may be used as the basis for screening the local community’s elderly with a high suicidal risk, and in the development of suicide prevention services.

Tension pneumoperitoneum during pneumatic reduction of pediatric intussusception: case report

This paper presents a case report of tension pneumoperitoneum that occurred in a 4-month-old girl with intussusception during pneumatic reduction. Tension pneumoperitoneum is a rare but life threatening complication in air pressure enema that is commonly used to turn the intussuscepted bowel to its original position. The incidence of a simple pneumoperitoneum due to a bowel perforation associated with attempted pneumatic reduction for intussusception is as high as 4%. The simple pneumoperitoneum changed rapidly to tension pneumoperitoneum and immediate needle decompression was life-saving in this case. Similar to a tension pneumothorax, the diagnosis is clinical and management should not be delayed awaiting other confirmatory tests. The emergency physician must recognize this rare complication of pneumatic reduction and promptly treat the ensuing tension pneumoperitoneum after bowel perforation with immediate needle decompression as a part of the initial resuscitation.

The changes of prevalence and etiology of pediatric pneumonia from National Emergency Department Information System in Korea, between 2007 and 2014 / 소아과

PURPOSE: Understanding changes in pathogen and pneumonia prevalence among pediatric pneumonia patients is important for the prevention of infectious diseases. METHODS: We retrospectively analyzed data of children younger than 18 years diagnosed with pneumonia at 117 Emergency Departments in Korea between 2007 and 2014. RESULTS: Over the study period, 329,380 pediatric cases of pneumonia were identified. The most frequent age group was 1–3 years old (48.6%) and the next was less than 12 months of age (17.4%). Based on International Classification of Diseases, 10th revision diagnostic codes, confirmed cases of viral pneumonia comprised 8.4% of all cases, pneumonia due to Mycoplasma pneumoniae comprised 3.8% and confirmed cases of bacterial pneumonia 1.3%. The prevalence of confirmed bacterial pneumonia decreased from 3.07% in 2007 and 4.01% in 2008 to 0.65% in 2014. The yearly rate of pneumococcal pneumonia also decreased from 0.47% in 2007 to 0.08% in 2014. A periodic prevalence of M. pneumoniae pneumonia (MP) was identified. CONCLUSION: The increased number of patients with pneumonia, bacterial pneumonia, pleural effusion, and empyema in 2011 and 2013–2014 resulted from an MP epidemic. We provide evidence that the frequency of confirmed cases of bacterial pneumonia and pneumococcal pneumonia has declined from 2007 to 2014, which can simultaneously reflect the effectiveness of the pneumococcal conjugate vaccine.

Gender Differences in Sleep Disturbance among Elderly Koreans: Hallym Aging Study

Sleep is an important component in our lives as it is necessary throughout one’s entire life span. This study was conducted to elucidate whether there are gender differences in sleep quality and what factors can affect sleep quality in community-dwelling elderly Koreans. A total of 382 subjects (175 males and 207 females) were recruited among elderly aged 45 or over who participated in the 2010 Hallym Aging Study (HAS). They were invited to a general hospital and were evaluated for socioeconomic status, smoking history, and various clinical measures. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). A higher score indicates poorer subjective sleep quality, (PSQI global score > 5 suggests sleep disturbance). After adjusting for potential covariates, our results show that alcohol increases the odds for poor sleep (odds ratio [OR] = 3.35, 95% confidence interval [CI] = 1.11–10.10) in males. In females, lack of exercise was the major risk factor of poor sleep as they are 4.46 times more likely to suffer from low sleep quality than those who exercise regularly (95% CI=1.56–13.75). Stress was also a risk factor for poor sleep. It was 5.60 times higher in the "always have stress" group than the "do not have stress" group (95% CI = 1.54–20.34). Thus, alcohol consumption is associated with men’s sleep quality, while exercise and stress level affect women's.

Concomitant inhibition of renin angiotensin system and Toll-like receptor 2 attenuates renal injury in unilateral ureteral obstructed mice

BACKGROUND/AIMS: There has been controversy about the role of Toll-like receptor 2 (TLR2) in renal injury following ureteric obstruction. Although inhibition of the renin angiotensin system (RAS) reduces TLR2 expression in mice, the exact relationship between TLR2 and RAS is not known. The aim of this study was to determine whether the RAS modulates TLR2. METHODS: We used 8-week-old male wild type (WT) and TLR2-knockout (KO) mice on a C57Bl/6 background. Unilateral ureteral obstruction (UUO) was induced by complete ligation of the left ureter. Angiotensin (Ang) II (1,000 ng/kg/min) and the direct renin inhibitor aliskiren (25 mg/kg/day) were administrated to mice using an osmotic minipump. Molecular and histologic evaluations were performed. RESULTS: Ang II infusion increased mRNA expression of TLR2 in WT mouse kidneys (p < 0.05). The expression of renin mRNA in TLR2-KO UUO kidneys was significantly higher than that in WT UUO kidneys (p < 0.05). There were no differences in tissue injury score or mRNA expression of monocyte chemotactic protein 1 (MCP-1), osteopontin (OPN), or transforming growth factor beta (TGF-beta) between TLR2-KO UUO and WT UUO kidneys. However, aliskiren decreased the tissue injury score and mRNA expression of TLR2, MCP-1, OPN, and TGF-beta in WT UUO kidneys (p < 0.05). Aliskiren-treated TLR2-KO UUO kidneys showed less kidney injury than aliskiren-treated WT UUO kidneys. CONCLUSIONS: TLR2 deletion induced activation of the RAS in UUO kidneys. Moreover, inhibition of both RAS and TLR2 had an additive ameliorative effect on UUO injury of the kidney.

Recurrent Intussusceptions in Identical Twins, Visited to Emergency Department

This report presents a set of identical twins who had recurrent intussusceptions. One twin had intussusception 3 times, and the other had it 7 times. They were usually diagnosed by ultrasonography and reduced by air contrast enema. Manual operative reduction was performed separately for each one due to failure of the enema. Unfortunately, we still could not determine the exact cause. A few cases of intussusceptions in identical twins within a few days of each other have been reported, which may be the result of a congenital predisposition triggered by an acquired agent. We report a rare case of recurrent intussusceptions in identical twins within 4 years.

The Relationship between Height and Cognitive Function among Community-dwelling Elderly: Hallym Aging Study / 한국역학회지

OBJECTIVES: Height is known as an index that reflects the environment of the fetal, childhood, and adolescent periods, which affect adult health. This study was conducted to elucidate whether height is associated with cognitive impairment in community-dwelling elders in Korea. METHODS: The study subjects were recruited among community dwelling elderly individuals aged 65 or over who participated in the 2004 Hallym Aging Study. They were invited to a general hospital and were evaluated for socioeconomic status, smoking history, and various clinical measures. Cognitive function measurement was performed using the Korean-Mini Mental State Examination. Logistic regression was used to evaluate the association between height and cognitive function. RESULTS: After adjusting for potential covariates such as age and education, the smallest group was associated with higher risk of cognitive impairment compared with the tallest group among elderly men (odds ratio [OR], 4.20; 95% confidence interval [CI], 1.02-17.36), but not among elderly women (OR,1.65; 95% CI, 0.62-4.40). CONCLUSIONS: The reason for this difference according to sex may be explained by the differential effects of education on cognitive function by sex. A larger population-based prospective cohort study is needed to examine the association between height and cognitive function according to sex.

The Relationship between Smoking, Socioeconomic Status and Grip Strength among Community-dwelling Elderly Men in Korea: Hallym Aging Study / 한국역학회지

OBJECTIVES: Low grip strength is associated with decline in bone mineral density (BMD) and increased risk of spine fracture among the elderly. Smoking, a major factor determining BMD, is also known to have an indirect effect on bone loss. This study investigated whether smoking is associated with grip strength in the community-dwelling elderly in Korea. METHODS: This study was an outcome of the second of three waves of the Hallym Aging Study from January to May 2007, a population-based study of Koreans aged 45 years and upwards dwelling in Chuncheon. Its 218 subjects comprised men aged 65 years or over. They were evaluated at a general hospital for socioeconomic status, smoking history, and various clinical measures including grip strength. RESULTS: Grip strength was higher in non-, ex-, and current smokers (33.7 kg, 30.6 kg, and 29.3 kg, respectively). Current smoking was found to increase the risk of decreased grip strength (adjusted odds ratio [aOR], 4.58; 95% confidence interval [CI],1.31 to 16.04) compared with non-smoking, after adjustment for potential covariates including socioeconomic status. After adjustment for smoking effect, education of fewer than six years and monthly income of fewer than 500,000 Korean won increased the risk of decreased grip strength compared with education of more than six years (aOR, 2.88; 95% CI, 1.08 to 7.66) and monthly income of more than 1,500,000 Korean won (aOR, 2.86; 95% CI, 1.08 to 7.54). CONCLUSIONS: These results showed that current smoking, low education and low income were independent risk factors for decreased grip strength among elderly men in Korea.

Th17 Cells Are Not Directly Associated with Renal Ischemia-Reperfusion Injury / 대한신장학회지

PURPOSE: Interleukin-17-producing T cell (Th17 cell) is a newly discovered subtype of helper T cell. Its function and importance in the pathogenesis of a broad range of immune diseases are under active investigation. However, little is currently known about the role of Th17 cells in ischemia-reperfusion (IR) injury of the kidney, a common pathophysiologic occurrence in various renal disease processes. METHODS: We measured the number of infiltrated T lymphocytes and Th17 cells in C57Bl/6 mouse kidneys in sham-operated controls and following varying degrees of renal IR injury induced by renal pedicle clamping and reperfusion. The cell count results were compared to accompanying histologic damage and serum creatinine levels after 35 min and 45 min of ischemia, and following reperfusion of 48, 72, 96, and 168 hrs. RESULTS: The number of T lymphocytes increased as ischemia time increased. However, the number of Th17 cells was not significantly affected by prolonged ischemia and reperfusion. Furthermore, the degree of histologic damage and serum creatinine levels did not correlate with the T lymphocyte and Th17 cell count numbers. CONCLUSION: We did not observe any evidence that Th17 cells are directly linked to renal tissue damage caused by IR injury. The role and importance of helper T cells in renal IR injury need to be evaluated further in the light of the interaction with Th1, Th2, and regulatory T cells rather than Th17 alone.

A Case of Enterovirus 71 Infection Presented with Acute Flaccid Paralysis

Hand-foot-mouth disease (HFMD) is characterized by distinctive skin lesions on the hand, foot, and mouth and in general, recovery occurs within one week. However, in cases of HFMD by enterovirus 71 (EV71) infection, the development of neurologic complications such as brainstem encephalitis, acute flaccid paralysis, and aseptic meningitis has been common. Moreover, it has been reported that some patients with neuologic complications have expired in severe cases. Here, we report a case of EV71 infection presented with acute flaccid paralysis of a single similar to paralytic poliomyelitis.

Genome-wide Association Study Identified TIMP2 Genetic Variant with Susceptibility to Osteoarthritis

Osteoarthritis (OA) is the most common degenerative joint disorder in the elderly population. To identify OA-associated genetic variants and candidate genes, we conducted a genome-wide association study (GWAS). A total 3,793 samples (476 cases: wrist + knee and 3317 controls) from a community-based epidemiological study were genotyped using the Affymetrix SNP 5.0. An intronic SNP (rs4789934) in the TIMP2 (tissue inhibitor of metalloproteinase-2) showed the most significance with OA (odd ratio [OR] = 2.06, 95% confidence interval [CI] = 1.52-2.81, p = 4.01 x 10(-6)). Furthermore, a polymorphism (rs1352677) in the NKAIN2 (Na+/K+ transporting ATPase interacting 2) was suggestively associated with OA (OR = 1.43, CI = 1.22-1.66, p = 7.01 x 10(-6)). The present study provides new insights into the identification of genetic predisposing factors for OA.

A Case of Thyrotoxic Periodic Paralysis in Adolescent with Graves' Disease / 대한소아내분비학회지

Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by recurrent paralysis of skeletal muscle and hypokalemia caused by a massive intracellular shift of potassium. TPP mainly affects young male patients of Asian descent. We describe a case of TPP in a 14-year-old girl who presented with palpitation and intermittent weakness of the lower extremities especially after physical exercises. The patient showed sinus tachycardia, proximal weakness of both legs and a severe hypokalemia. Thyroid function tests showed hyperthyroidism, and thyroid scan revealed diffusely enlarged goiter consistent with Graves' disease. After the management with antithyroid drug, beta-adrenergic blocker and potassium supplementation for TPP, she has remained euthyroid state and symptom free on the follow-up. TPP should be considered in children with acute paralysis of skeletal muscle and hypokalemia, also thyroid function should be evaluated.

Prevalence of Knee Pain and Its Influence on Quality of Life and Physical Function in the Korean Elderly Population: A Community Based Cross-Sectional Study

To investigate the prevalence of knee pain and its influence on physical function and quality of life (QOL), we examined 504 community residents of Chuncheon, aged > or = 50 yr. Demographic information was obtained by questionnaire, and radiographic evaluations consisted of weight-bearing semi-flexed knee anteroposterior radiographs. Self-reported QOL and function were assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and Short Form 12 (SF-12). Performance-based lower extremity function was assessed using the tests consisting of standing balance, usual walk and chair stands. The prevalence of knee pain was 46.2% (32.2% in men and 58.0% in women) and increased with age in women. After adjustment of confounders including the presence of knee OA, the subjects with knee pain had significantly worse WOMAC function and SF-12 scores compared to subjects without knee pain. Among the subjects with knee pain, women had worse WOMAC and SF-12 scores than men. Subjects with knee pain had worse physical performance score compared to those without knee pain, especially among females. In conclusion, the prevalence of knee pain is high (32.2% in men and 58.0% in women) in this elderly community population in Korea. Independent of knee OA and other confounding factors, subjects with knee pain have more than 5-fold increase in the risk of belonging to the worst lower extremity function compared to subjects without knee pain.

Association between Lower Urinary Tract Symptoms and Vascular Risk Factors in Aging Men: The Hallym Aging Study

PURPOSE: The aim of this study was to investigate the relationship between lower urinary tract symptoms (LUTS) and risk factors for vascular diseases in a population-based cohort study, the Hallym Aging Study (HAS). MATERIALS AND METHODS: Among the 1,520 participants in HAS, 280 men aged more than 50 years, who underwent detailed health evaluations, including health-related questionnaires, evaluations of their medical history, and various life style factors, as well as clinical measurements, were included in the study. Vascular risk factors used in the present study including hypertension, diabetes mellitus, hyperlipidemia, and smoking and were assessed by medical history and clinical measurements. LUTS were assessed by validated questionnaires, the International Prostate Symptom Score (IPSS), and the relationship between LUTS and vascular risk factors was investigated. RESULTS: Of the 280 men, 175 (62.5%) had moderate/severe LUTS (IPSS>7) and 260 (93%) had one or more vascular risk factors. The IPSS was similar in those with no (11.6+/-9.7) and one or two (11.5+/-8.5) vascular risk factors, but increased to 15.1+/-9.3 in those with 3 or more vascular risk factors (p<0.05). The multiple logistic regression analysis, controlling for age and body mass index (BMI) showed that men with 3 or more vascular risk factors were 3 times more likely to have moderate/severe LUTS than men without vascular risk factors (p<0.05). CONCLUSIONS: Men with risk factors for vascular diseases are more likely to have LUTS and these findings suggest that vascular risk factors play a role in the development of LUTS.

Association between Lower Urinary Tract Symptoms and Vascular Risk Factors in Aging Men: The Hallym Aging Study

PURPOSE: The aim of this study was to investigate the relationship between lower urinary tract symptoms (LUTS) and risk factors for vascular diseases in a population-based cohort study, the Hallym Aging Study (HAS). MATERIALS AND METHODS: Among the 1,520 participants in HAS, 280 men aged more than 50 years, who underwent detailed health evaluations, including health-related questionnaires, evaluations of their medical history, and various life style factors, as well as clinical measurements, were included in the study. Vascular risk factors used in the present study including hypertension, diabetes mellitus, hyperlipidemia, and smoking and were assessed by medical history and clinical measurements. LUTS were assessed by validated questionnaires, the International Prostate Symptom Score (IPSS), and the relationship between LUTS and vascular risk factors was investigated. RESULTS: Of the 280 men, 175 (62.5%) had moderate/severe LUTS (IPSS>7) and 260 (93%) had one or more vascular risk factors. The IPSS was similar in those with no (11.6+/-9.7) and one or two (11.5+/-8.5) vascular risk factors, but increased to 15.1+/-9.3 in those with 3 or more vascular risk factors (p<0.05). The multiple logistic regression analysis, controlling for age and body mass index (BMI) showed that men with 3 or more vascular risk factors were 3 times more likely to have moderate/severe LUTS than men without vascular risk factors (p<0.05). CONCLUSIONS: Men with risk factors for vascular diseases are more likely to have LUTS and these findings suggest that vascular risk factors play a role in the development of LUTS.

A Case of Silver-Russell Syndrome Diagnosed in the Patient Admitted with Hypoglycemic Seizure

The Silver-Russell syndrome(SRS) is a clinically heterogeneous syndrome characterized by intrauterine and postnatal growth retardation with spared cranial growth, characteristic facial features, and body asymmetry. Although mild to moderate hypoglycemic symptoms occasionally appear in children with SRS especially those who are not fed frequently and regularly, hypoglycemic seizures rarely occur. We report a rare case of SRS which was diagnosed in a 4-year-old female who admitted with hypoglycemic seizure. The patient showed the characteristic features of SRS. Endocrinologic studies were normal except for partial growth hormone insufficiency. To prevent seizures and chronic neurologic deficits in children with SRS, the early recognition and appropriate management of hypoglycemia is critical.

A Case of Hemophilia A Diagnosed in a Premature Infant

Although the majority of abnormal bleeding during the neonatal period results from acquired coagulation disorders, inherited coagulation disorders can also manifest at this time. Hemophilia is the most common of inherited coagulation disorder. Although 40-70% of cases with hemophilia are diagnosed in the neonatal period, few cases have been reported in premature infants. We report a case of a premature infant born at 31 weeks of gestation, diagnosed with hemophilia A by blood coagulation test, coagulation factor assay and study of the F8 gene. The baby was treated with recombinant factor VIII (Recombinate(R), USA) because of repeated seizures and intramuscular hematoma.

The Prevalence of Knee Osteoarthritis in Elderly Community Residents in Korea

The purpose of this study was to estimate the prevalence of radiographic and symptomatic knee osteoarthritis (OA) among community residents and to elucidate the relevant risk factors. This prospective, population-based study was conducted on residents over 50 yr of age in Chuncheon. Subjects completed an interview based on a standardized questionnaire and clinical evaluation including standardized weight bearing semiflexed knee A-P radiographs. We defined a subject with the Kellgren and Lawrence grade > or =2 as having radiographic knee OA (ROA). Symptomatic knee OA (SOA) was defined by the presence of both ROA and knee pain. We obtained symptom information and radiographs from 504 subjects. The prevalence of ROA and SOA was 37.3% and 24.2%, respectively. The prevalence of both ROA and SOA was significantly higher among women than among men. Multivariate analysis revealed that the presence of hypertension, and a manual occupation were significantly associated with the presence of ROA and SOA. Lower level of education was significantly associated with the presence of ROA, and female sex with the presence of SOA. In conclusion, both ROA and SOA are common in the aged adult population of Korea, with preponderance for women.