The effect of wireless LAN-based PACS device for portable imaging modalities.

The aim of this study was to develop wireless Picture Archiving and Communication System (PACS) device and to analyze its effect on image transfer from portable imaging modalities to the main PACS server. Using a laptop computer equipped with wireless local area network (LAN), the authors developed a wireless PACS device with DICOM modality worklist and DICOM storage server modules. This laptop computer could be easily fixed to portable imaging modalities such as ultrasound machines. From May to August 2007, 112 portable examinations were evaluated. Of these, 62 were done with wireless LAN-based PACS device, and 50 were done without wireless PACS device. To evaluate the impact of the wireless LAN-based PACS device on productivity and workflow, we analyzed the mean time delay and standard deviations (SD) both in cases where wireless LAN-based PACS device was used and in cases where it was not used. Statistical analysis was performed using a t test. The mean time interval from image acquisition to storage in the main PACS when the wireless LAN-based PACS device was used was 342.4 s (5 min and 42.4 s, SD = 509.2 s). When the wireless PACS was not used, the mean time interval was 2,305.5 s (38 min and 25.5 s, SD = 1,371.8 s). The mean time interval was statistically different between the two groups (t test, p < 0.001). The wireless LAN-based PACS device could help in reducing the storage intervals of images obtained by portable machines and in promoting effective and rapid treatment of patients who have undergone portable imaging examinations.

Familial association of schizophrenia symptoms retrospectively measured on a lifetime basis.

OBJECTIVE: The objective of this study was to characterize the familial associations of symptoms or symptom dimensions of schizophrenia, as a component of the effort to delineate suitable phenotypic markers under the homogenous genetic control. METHODS: Clinical symptoms of the patients were evaluated on a lifetime basis, with the Korean version of the Diagnostic Interview for Genetic Studies and the Krawieka scale. Our sample consisted of 54 sibling pairs who were concordant for Diagnostic and statistical manual of mental disorder-IV schizophrenia or schizoaffective disorder. RESULTS: At the individual symptom level measured by the Diagnostic Interview for Genetic Studies, we observed a statistically significant degree of concordance within the sibling pairs for auditory hallucination (kappa=0.600, chi(2)=15.193, P=0.000). The within-sibling resemblance of this symptom was also indicated by the results of correlation analyses of individual items of the Krawiecka scale (partial correlation coefficient=0.423, P=0.005). Among the individual symptoms or symptom dimensions of the Krawiecka scale, the 'anxious' (partial correlation coefficient=0.469, P=0.001) and the 'affective dimension' (including the items of 'anxious' and 'depressed') (partial correlation coefficient=0.436, P=0.003) were also determined to indicate significant intra-pair correlations after controlling for potential confounding variables, such as sex, duration of illness, and age of onset. CONCLUSIONS: The results of this study suggest that familial factors, possibly genetic factors, contribute a liability to the development of auditory hallucinations. This symptom might then prove useful as a phenotype marker in future genetic studies.

Posttraumatic Embitterment Disorder and Hwa-byung in the General Korean Population.

OBJECTIVE: Posttraumatic embitterment disorder (PTED) is characterized by states of "embitterment", characteristically similar to "Hwa-byung", which is a Korean culture-bound syndrome. The present study aimed to assess diagnostic relationships between PTED and Hwa-byung. METHODS: A total of 290 participants completed our survey. PTED and Hwa-byung were diagnosed using a diagnostic interview and scale. Scales for depression, suicide ideation, and anger were used for evaluation. Fisher's exact tests and Mann-Whitney U tests were performed to evaluate diagnostic overlap between PTED and Hwa-byung, and associations of scale scores for depression, suicide ideation, and anger between the PTED, Hwa-byung, and non-diagnosed groups. Associations of these scales between the depressive and non-depressive groups, and suicidal and non-suicidal groups were also evaluated. RESULTS: Among the participants, 1.7% of the sample fit the diagnostic criteria for PTED and 2.1% fit the criteria for Hwa-byung. No individual fit the criteria for both. Anger scores were significantly higher in the Hwa-byung group than in the non-diagnostic group. There were not any significant differences in anger scores between the PTED and non-diagnostic groups. Depression scores were significantly higher in the PTED than in the non-diagnostic groups. In contrast, no significant differences were observed between depression scores in the Hwa-byung and non-diagnostic groups. CONCLUSION: These results suggest that PTED may be a disorder category that is distinct from Hwa-byung.

The effects of long-term clozapine add-on therapy on the rehospitalization rate and the mood polarity patterns in bipolar disorders.

OBJECTIVE: We investigated the effect long-term clozapine add-on therapy has on rehospitalization rate and mood polarity patterns in patients with bipolar disorders. METHOD: Clinical data from medical records of 51 patients with bipolar disorder (DSM-IV) treated with clozapine add-on for more than 6 months at the Refractory Bipolar Disorders Clinic of Seoul National University Hospital were retrospectively analyzed. Patients had been registered from 1995 to 2004. Rehospitalization rates were compared before and after clozapine add-on. The clinical polarity of episodes resulting in hospitalizations was also compared. Twenty-seven bipolar patients treated with clozapine add-on for more than 3 years were further analyzed for long-term stability. RESULTS: The number of hospital days per year was reduced in 90.2% of patients after clozapine add-on. Total number and duration of hospitalizations per year decreased, and the effect size of clozapine add-on was substantially large (Wilcoxon z = -5.48, p < .01 for number of hospitalizations/year; Wilcoxon z = -5.32, p < .01 for hospital days/year; r = -0.54 and -0.53, respectively). Significant reductions were found in the number and duration of hospitalizations associated with manic, depressive, and hypomanic episodes. Number and duration of hospitalizations associated with mixed episodes did not show significant changes. The long-term efficacy of clozapine add-on was supported by continuous reduction in hospital days per year in the 27 selected patients. CONCLUSION: Long-term clozapine add-on therapy was effective in reducing the number and duration of rehospitalizations of bipolar patients resistant to conventional treatment. A significant reduction was found in rehospitalizations associated with manic, depressive, and hypomanic episodes, whereas mixed episode-associated rehospitalizations did not show significant changes.

Fractal dimension of cerebral cortical surface in schizophrenia and obsessive-compulsive disorder.

Schizophrenia and obsessive-compulsive disorder (OCD) are assumed to be neurodevelopmental disorders. To examine the cortical patterns in the two disorders, three-dimensional fractal dimension (FD) of skeletonized cerebral cortical surface was estimated from magnetic resonance (MR) images of 50 patients with schizophrenia, 45 patients with OCD and 26 healthy normal controls. The schizophrenic group had a significantly smaller mean FD than OCD group, and the OCD group than normal controls. The FD revealed a significant interaction effect of group-by-hemisphere, and the FD asymmetry index distinguished the schizophrenic group from normal controls. In logistic regression models, the FD and CSF volume correctly classified 95.6% of the schizophrenics from the controls and 88.0% of the patients with OCD from the controls. In the control and schizophrenic groups, the FD was not associated with any of tissue volume measures. In the OCD group, however, the FD was significantly correlated with gray matter tissue volume and intracranial volume (ICV). The results of the present study suggest that three-dimensional FD of cortical surface may be a sensitive indicator for investigation of the structural brain abnormalities in mental disorders, especially those developmentally disturbed. Further studies to explore regional FD changes in mental disorders and clinical implications of the FD including diagnostic value should be performed in the future.

N-methyl-D-aspartate receptor in working memory impairments in schizophrenia: event-related potential study of late stage of working memory process.

Working memory (WM) deficit in schizophrenic patients has been well established. Still, underlying biological substrate of the impairment is not clear. Among neurotransmitter hypotheses of schizophrenia, N-methyl-D-aspartate (NMDA) receptor model is mostly supported, considering that NMDA receptor antagonist can elicit both psychosis and cognitive impairment observed in schizophrenic patients. In current study, to test the neuropsychological and the electrophysiological effects of NMDA receptor in WM, event-related potentials (ERPs) of Sternberg's short-term memory scanning task (SMST) were analyzed in 10 healthy subjects under intravenous administration of a subanesthetic dose of ketamine (0.65 mg/kg/h) or placebo (normal saline). Late positive component (LPC) of ERP was hypothesized to reflect later stage of WM. Brief Psychiatric Rating Scale score was significantly increased (t=-5.75, df=9, P<.001) and correct response rate was significantly decreased (t=2.21, df=9, P=.054) after ketamine administration. Neither reaction time nor LPC latency, which reflect memory scanning time, was changed. Amplitude of LPC was significantly reduced after ketamine administration (z=-2.31, number of observations=120, P=.021). In conclusion, NMDA receptor antagonist administration elicited WM deficit both in behavioral and electrophysiological level. Electrophysiological component reflecting later stage of WM was impaired by NMDA antagonist.

Relationship between personality trait and regional cerebral glucose metabolism assessed with positron emission tomography.

There have been no studies systematically investigating relationships between biogenetic temperament dimensions and patterns of brain glucose metabolism. Nineteen healthy subjects were evaluated regarding the biogenetic temperament using Cloninger's Temperament and Character Inventory (TCI). In addition, [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET) was used to measure regional brain glucose metabolism. Voxel-based correlation analysis was used to test correlations between regional brain glucose metabolism and scores on the TCI. We identified that each temperament dimension, such as Novelty Seeking, Harm Avoidance, and Reward Dependence, was significantly correlated with specific brain regions. The majority of correlations were observed in the areas of paralimbic regions and temporal lobes. The current study provides evidence linking each biogenetic temperament dimension with specific brain areas and provides a promising base for future personality research.

Gray matter abnormalities in paranoid schizophrenia and their clinical correlations.

Numerous imaging studies have shown structural brain abnormalities in schizophrenia. Recently, voxel-based morphometry enabled whole brain analysis beyond the regions of interest (ROI). Regional gray matter concentrations of magnetic resonance (MR) images from 35 patients with paranoid schizophrenia were compared with those from 35 age- and sex-matched controls, and their clinical correlations were explored using voxel-based morphometry. Gray matter concentrations in the patients were significantly reduced in the left insular and dorsolateral prefrontal regions, and bilaterally in the medial frontal, anterior cingulate, inferior frontal and superior temporal regions. On the other hand, gray matter concentrations in the bilateral cerebellum and right striatum were significantly increased in the patients compared with controls. A negative correlation between the score for the severity of 'lack of insight and judgment' and gray matter concentrations in the left posterior and right anterior cingulate and bilateral inferior temporal regions including the lateral fusiform gyri was found. These results suggest the important roles of the paralimbic structures in the pathophysiology of schizophrenia and the involvement of the perceptual and monitoring systems in the mechanism of insight.

Ubiquitous healthcare service using Zigbee and mobile phone for elderly patients.

OBJECTIVE: To investigate the efficacy of a u-healthcare service using Zigbee and mobile phone for elderly patients with diabetes mellitus or heart diseases. MATERIALS AND METHODS: From July to October, 2005, 29 patients were enrolled in our study. Two selected u-healthcare items, ECG and blood glucose measurement, were monitored. Twenty patients were provided with ZigBee built-in blood glucometer and mobile phones, and were instructed on using a web service where the measured blood glucose could be transmitted directly to the web and be administrated. Nine patients participated in ECG monitoring, by using a wireless, transmittable ECG recording instrument equipped with ZigBee protocol attached to their chest. Daily average transmission frequency, rate of transmission loss, and error reasons were analyzed. In addition, the patients were asked to score their degree of satisfaction about the sensors and u-healthcare services. RESULTS: The mean transmission frequencies were 2.1 times/day in blood glucose monitoring and 6.1 times/day in ECG. The patients' satisfaction scores of the blood glucometer and service used in this research were 8.59 and 9.01 of 10 points, respectively. The mean satisfaction scores about ECG sensor and ECG monitoring services were 5.79 and 7.29, respectively. DISCUSSION: Despite the many problems still encountered such as technological problems related to sensors and some problems like battery replacement, we could transfer the data of glucometer and ECG sensors to web-server via ZigBee protocol. Authors think the ZigBee could be one of components of wireless u-healthcare systems in the future due to its advantages of lower power consumption.

Neuroleptic-induced acute and chronic akathisia: a clinical comparison.

We compared the severity of subjective and objective symptomatology of akathisia between the acute and chronic subtypes of neuroleptic-induced akathisia. Sixty-one schizophrenic subjects were evaluated. Multivariate analysis revealed that motor manifestations and distress of akathisia were less severe in chronic akathisia than in acute akathisia. The severity of subjective restlessness was not significantly different between the two groups. In conclusion, there were differences in the severity of symptoms and signs between the acute and chronic subtypes of akathisia, suggesting that the severity of the subjective and objective components of akathisia may be differentially affected by the duration of akathisia.

Managing the CT data explosion: initial experiences of archiving volumetric datasets in a mini-PACS.

Two image datasets (one thick section dataset and another volumetric dataset) were typically reconstructed from each single CT projection data. The volumetric dataset was stored in a mini-PACS with 271-Gb online and 680-Gb nearline storage and routed to radiologists' workstations, whereas the thick section dataset was stored in the main PACS. Over a 5-month sample period, 278 Gb of CT data (8976 examinations) was stored in the main PACS, and 738 Gb of volumetric datasets (6193 examinations) was stored in the mini-PACS. The volumetric datasets formed 32.8% of total data for all modalities (2.20 Tb) in the main PACS and mini-PACS combined. At the end of this period, the volumetric datasets of 1892 and 5162 examinations were kept online and nearline, respectively. Mini-PACS offers an effective method of archiving every volumetric dataset and delivering it to radiologists.

Metric characteristics of the drug-induced extrapyramidal symptoms scale (DIEPSS): a practical combined rating scale for drug-induced movement disorders.

The metric properties of the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) were examined in 182 subjects treated with antipsychotics. Inter-rater reliability, test-retest reliability, and concurrent validity with other rating scales for EPS were high. Four factors were identified and the optimal diagnostic cut-off scores were obtained. These results suggest that the DIEPSS is a reliable and valid multidimensional rating scale.

Statistical parametric mapping of LORETA using high density EEG and individual MRI: application to mismatch negativities in schizophrenia.

We describe a method for the statistical parametric mapping of low resolution electromagnetic tomography (LORETA) using high-density electroencephalography (EEG) and individual magnetic resonance images (MRI) to investigate the characteristics of the mismatch negativity (MMN) generators in schizophrenia. LORETA, using a realistic head model of the boundary element method derived from the individual anatomy, estimated the current density maps from the scalp topography of the 128-channel EEG. From the current density maps that covered the whole cortical gray matter (up to 20,000 points), volumetric current density images were reconstructed. Intensity normalization of the smoothed current density images was used to reduce the confounding effect of subject specific global activity. After transforming each image into a standard stereotaxic space, we carried out statistical parametric mapping of the normalized current density images. We applied this method to the source localization of MMN in schizophrenia. The MMN generators, produced by a deviant tone of 1,200 Hz (5% of 1,600 trials) under the standard tone of 1,000 Hz, 80 dB binaural stimuli with 300 msec of inter-stimulus interval, were measured in 14 right-handed schizophrenic subjects and 14 age-, gender-, and handedness-matched controls. We found that the schizophrenic group exhibited significant current density reductions of MMN in the left superior temporal gyrus and the left inferior parietal gyrus (P < 0. 0005). This study is the first voxel-by-voxel statistical mapping of current density using individual MRI and high-density EEG.

Optimized individual mismatch negativity source localization using a realistic head model and the Talairach coordinate system.

The purpose of this study is to evaluate the difference between anatomical locations of mismatch negativity (MMN) generators using a realistic head model and the Talairach coordinate system. This was performed by dipole source analysis by using a high density 128 channel electroencephalography (EEG) acquisition system and the subjects' individual 3D magnetic resonance images (MRI) for the realistic head model, in 24 healthy subjects. For dipole source localization, both the Talairach coordinate system and the individual MRI realistic head models were used and location results were compared. The MMN generators were clearly localized in the superior temporal gyri, especially in Heschl's gyrus, according to each individual's structural MRI. Only 37.5% of subjects showed the same anatomical locations of the MMN generator in both hemispheres in the realistic head model and in Talairach coordinate system, but fifteen subjects (62.5%) didn't. This result indicates that individually registered functional locations are desirable for the precise localization of activated areas in functional imaging studies and that a brain coordinate system is needed which adequately accounts for ethnic differences.

Three-year follow up of women with and without borderline personality disorder: development of Cloninger's character in adolescence.

The purpose of the present study was to examine the developmental patterns of Cloninger's biogenetic character traits in subjects with borderline personality disorder (BPD). Study subjects met Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised; DSM-III-R) criteria for BPD without comorbid axis I or II disorders, as determined by the Diagnostic Interview for Borderlines-Revised, Structured Clinical Interview for the DSM-III-R, and Diagnostic Interview for Personality Disorders. The BPD subjects and age- and sex-matched healthy comparison subjects were initially interviewed for Cloninger's biogenetic characters and re-interviewed at an interval of 1 year for the following 3 years. There were significant differences in the developmental patterns of self-directedness, cooperativeness, and self-transcendence between BPD and healthy comparison subjects (significant group by time interaction: repeated measures manova, F = 17.3, d.f. = 3,240, P < 0.001; F = 28.5, d.f. = 3,240, P < 0.001; F = 4.7, d.f. = 3,240, P < 0.01, respectively). The BPD subjects had less changes in character-related maturity with increasing age than did healthy comparison subjects. Post-hoc tests with Duncan's statistics revealed that subjects with BPD had significantly lower scores on self-directedness at all assessment time periods (P < 0.01) and lower scores on cooperativeness at the second-year and third-year follow-up assessments as compared to healthy comparison subjects (P < 0.01). The BPD subjects had a distinctively different developmental pattern of Cloninger's character compared to healthy comparison subjects. The character development of BPD patients was more fixed and immature than those of healthy comparison subjects.