• Title/Summary/Keyword: Improvement Index

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Infliximab: The Benefit for Refractory Crohn Disease and Top-down Induction Therapy in Severe Crohn Disease (Infliximab: 불응성 크론병 치료법으로서의 유용성과 Top-down 관해 유도 요법으로서의 가능성)

  • Lee, Jee-Hyun;Lee, Hae-Jeong;Park, Sung-Eun;Choe, Yon-Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.11 no.1
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    • pp.28-35
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    • 2008
  • Purpose: The aim of this study is to report the efficacy of infliximab, a monoclonal antibody directed against tumor necrosis factor alpha which is used for both treatment of refractory pediatric Crohn disease (CD) and induction of remission. Methods: Among pediatric patients who were diagnosed with CD at Samsung Medical Center between March 2001 and August 2007, a total of 16 patients were given infliximab to treat conventional therapyresistant refractory CD and severe active CD for induction of remission. Patients needing maintenance therapy were treated with an infliximab infusion every 8 weeks, and fistulizing CD patients occasionally received the infusion upon the condition that a fistula developed. The efficacy of treatment was assessed by comparing the Pediatric Crohn Disease Activity Index (PCDAI), Hct, ESR, CRP, and serum albumin levels using paired t-test. Results: The male/female ratio was 13:3, and the median age was 13 years (range, 21 months~15 years). The patients included 7 cases of therapy-resistant refractory CD, 7 cases of severe active CD, and 2 cases of fistulizing CD. Mean PCDAI before infliximab therapy was 34.19${\pm}$14.96, and mean follow-up PCDAI within 2 to 4 weeks after the last infusion was significantly lower, at 6.88${\pm}$10.31 (p=0.000). Hematological markers such as ESR (p=0.000), serum albumin (p=0.016), and CRP (p=0.009) also improved significantly after infusion. Remission was achieved in 2 of 4 patients refractory to conventional therapy. Among 3 steroid-dependent patients, 2 were able to discontinue steroid therapy, and dose reduction was possible in 1 patient. Remission after top-down therapy without prior use of other immunomodulators was achieved in 6 weeks in all 7 of the patients who had severe CD. Nine of ten refractory fistulizing CD patients also showed improvement after infliximab therapy. Conclusion: Infliximab was effective in pediatric refractory CD for induction of remission and maintenance therapy, as well as in severe CD for top-down induction therapy. Furthermore, infliximab has contributed to steroid cessation and dose reduction. Long-term follow-up evaluation is needed to determine safety and efficacy of infliximab in the future.

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Effect of Red clay(Hwangto) on Growth Performance and Carcass Characteristics in Growing-Fattening Hanwoo Steers (육성비육 거세한우에 대한 황토 급여가 성장 및 도체특성에 미치는 효과)

  • Kang, S.W.;Kim, J.S.;Cho, W.M.;Chung, H.Y.;Ki, K.S.;Choe, S.B.
    • Journal of Animal Science and Technology
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    • v.44 no.3
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    • pp.315-326
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    • 2002
  • This study was conducted to examine the effects of Red clay(Hwangto) as feed additives with 26 Hanwoo steers at two regions for 540 days from six to 24 months of age on feed efficiency, meat quantity and meat quality. Feeding trial 1 was conducted with two treatment groups by five heads/treatment which were T1(Control) and T2(Control+ad libitum Hwangto) at National Livestock Research Institute. Feeding trial 2 was conducted with four treatment groups by four heads/treatment which were T1(Control), T2(Control+2% Hwangto), T3(Control+5% Hwangto) and T4(Control+ad libitum Hwangto) at a private Hanwoo breeding farm. In feeding trial 1, average daily gains by growing, fattening, finishing and over-all periods were 0.572, 0.866, 0.869 and 0.769kg in T1, and 0.537, 0.904, 0.857 and 0.766kg in T2, respectively. Average daily gain for growing and finishing period was high in T1 but in T2 for fattening period, which were not statistically significant. Also concentrates and TDN intakes per kg gains were not statistically significant by treatments. In carcass characteristic, dressed carcass and red meat percentage were high in T1 but in T2 for retailed cut percentage without significant difference. The yield index and shear force was 69 and 70, 4.4 and 6.1 kg/$cm^2$ in T1 and T2, respectively. In palatability traits, the panel test scores of juiciness, tenderness and flavor were 4.08 and 4.64, 3.42 and 3.96, 4.58 and 4.80 in T1 and T2, respectively. which showed a tendency to improvement in Hwangto feeding groups. In feeding trial 2, the range of average daily gains were 0.656(T6) to 0.772(T3), 0.937(T6) to 1.009(T5), 0.592(T3) to 0.675kg(T6) in growing, fattening and finishing period, respectively. Although it was high in T3, T5 and T6 at growing, fattening and finishing period, respectively, it was not significantly different by treatments. The ranges of concentrates and TDN intakes per kg gains were 8.71 to 9.50(average 9.05) and 7.52 to 7.64kg(average 7.55kg), they all were lower in Hwangto feeding groups than in control about 4.5 to 8.3% and 1.2 to 1.6%, respectively. In carcass characteristics, back-fat thickness, loin eye muscle area and yield index were not difference by treatments, but marbling scores were high in T5 and T6 than in percent. Summarizing above results, it may be concluded that the use of unprocessed Hwangto as feed additives for growing-fattening steers seems to improve meat quality but not red meat quantity and feed efficiency, and may be required to feed ad libitum during the finishing period.

Effects of Sen Tangle (Laminaria japonica) Extract and Fucoidan Components on Lipid Metabolism of Stressed Mouse (스트레스 부하 마우스의 지질대사에 미치는 다시마(Laminaria japonica)와 후코이단 성분의 영향)

  • CHOI Jin-Ho;KIM Dae-Ik;PARK Soo-Hyun;KIM Dong-Woo;KIM Chang-Mok;KOO Jae-Geun
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.33 no.2
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    • pp.124-128
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    • 2000
  • This study was designed to investigate the effects of sea tangle(Laminaria japonica) extract (Dasi-Ex group: dry base $4.0{\%}$) and fucoidan-added (Fuco-I, II, III group: fucoidan of $1.0{\%}, 2.0{\%}, 3.0{\%}$ added to Dasi-EX) drinks on lipid metabolism of stressed mice. ICR male mice ($20 {\pm} 2 g$) were fed experimental diets and given free through water bottle filled with these beverages instead of water for 18 days including sociopsychological stress of 4 days. Dasi-Ex and Fuco-I, II, III groups resulted in slight decreases $3{\$}$ in body weight gain and $6{\~}12{\%}$ in feed and gross efficiencies compared with control groups. Serum protein contents were slightly increased $1{\~}5{\%}$ by administrations of these beverages compared with control group, reflecting inhibitory effect of sociopsychological stress by increase of protein levels. Significant differences in serum cholesterol contents of Dasi-Ex and Fuco-I groups could not be obtained, but Fuco-II and III groups resulted in marked decreases ($13{\~}17{\%}$) in serum cholesterol contents compared with control group. LDL-cholesterol contents resulted in marked decreases ($about 20 and 25{\%}$, respectively) in Fuco-II and III groups, whereas HDL-cholesterol content was significantly increases ($about 16{\%}$) in Fuco-III group compared with control group. Fuco-I, II and III groups resulted in a marked decreases ($15{\%}, 20{\%} and 40{\%}$, respectively) in atherogenic index (AI) compared with control group. Significant differences in serum lipid peroxide (LPO) contents of Dasi-Ex and Fuco-I groups could not be obtained, but Fuco-II and III groups resulted in a significant decrease about $10{\%}$ in serum LPO contents compared with control group. These results suggested that fucoidan drinks added sea tangle could significantly inhibited chronic degenerative diseases by improvement of effective lipid metabolism or fucoidan component.

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Montelukast as an add-on therapy in bronchopulmonary dysplasia (기관지폐 이형성증의 추가 치료제로서의 Montelukast)

  • Kim, He Min;Song, Ji Eun;Lee, Soon Min;Park, Min Soo;Park, Kook In;Namgung, Ran;Lee, Chul
    • Clinical and Experimental Pediatrics
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    • v.52 no.2
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    • pp.181-186
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    • 2009
  • Purpose : Inflammation plays a potential role in the pathogenesis of bronchopulmonary dysplasia (BPD). Strategies for preventing BPD include respiratory management, antioxidants, nutritional treatment, and others such as anti-inflammatory agents. We aimed to assess the safety, tolerability, and efficacy of montelukast (MK), a cysteinyl leukotriene 1 receptor antagonist, as an add-on therapy in BPD. Methods : In addition to currently available standard measures such as oxygen supplementation, bronchodilators, nutritional support, and/or diuretics, montelukast was administered to 15 preterm infants with BPD. MK was given orally (1 mg/kg/d) for a mean period of 12 weeks. We compared safety and efficacy parameters with historical controls. Results : All 15 patients survived, and no differences were found in the incidence of adverse reactions between the 2 groups. The ventilation index was significantly improved after 2 weeks in MK group compared with historical controls. There were no significant differences in other respiratory parameters (MAP, oxygen dependency, and ventilator dependency) between the groups, but the MK group showed trends of greater improvement. Conclusion : Administration of MK 1 mg/kg/d was well tolerated in preterm BPD patients as an add-on therapy. We demonstrated that after 2 weeks of MK administration of 1 mg/kg/d, MK had beneficial therapeutic effects on BPD patients as an add-on to the standard therapy. Further multicenter randomized controlled clinical trials are needed to confirm the efficacy and safety of MK as a useful supplement to standard therapy for BPD patients.

The effects of Moxibustion Therapy on Chronic Low Back Pain, Daily Living Disability and Sleep Pattern in Elderly Women (뜸요법이 여성노인의 만성요통, 일상생활기능장애 및 수면양상에 미치는 효과)

  • Kim, Hye-Jeong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.7
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    • pp.301-310
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    • 2016
  • This is a nonequivalent control group non-synchronized experiment research to verify the effect of moxibustion therapy on efficient management of daily living disabilities and sleep patterns in elderly women with chronic low back pain. Total 12 sessions of moxibustion therapy were applied to elderly women(30 subjects in an experimental group and 30 subjects in a control group) in G City once a week for 12 weeks from March 15th to May $31^{st}$ 2015. Then the follow-up study was conducted 2 weeks after the post survey. For moxibustion, was applied to Shen-shu, Ashi point, Ta chang shu, Yang kuan and Yosu. 5 sheets of moxibustion were applied to 7 acupuncture points of Mugeukboyang moxibustion; Zu san li & Chu chi, Chung wan, Chung chi & Shui tao, Fei shu, Kao hung and Tien shu, Wijung respectively and experimental treatment was conducted. For assessing the degree of back pain, Visual Analog Scale(VAS) developed by Scott & Huskisson(1979) was used and for measuring the degree of daily living disability, Oswestry Disability Index, which was developed by Fairbank et al(1980) and translated and revised by Yim, Hyeon-sul et al.(1998), was used. For measuring sleep patterns, the sleep pattern measurement tool developed by Oh, Jin-su, Song, Mi-soon and Kim, Sin-mi(1998) was used. For data analysis, SPSS/WIN 18.0 was employed and Chi-square test, t-test and repeated measures ANOVA were performed. There were significant differences in pain score(F=2510.32, p<.001), daily living disability score(F=1937.82, p<.001) and sleep pattern score((F=15.54, p<.001) of elderly women that were provided with moxibustion therapy, compared to the control group. Therefore, it was found that moxibustion therapy made a positive contribution to reduction in pain and daily living disabilities and improvement in sleep quality. Based on this study finding, there is a need to apply moxibustion therapy to elderly people with chronic low back pain as a nursing intervention in future.

Association between the Number of Existing Permanent Teeth and Chronic Obstructive Pulmonary Disease (현존자연치아수와 만성폐쇄성폐질환과의 연관성)

  • Shin, Hye-Sun;Ahn, Yong-Soon;Lim, Do-Seon
    • Journal of dental hygiene science
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    • v.16 no.3
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    • pp.217-224
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    • 2016
  • The aim of this study was to evaluate whether the number of existing permanent teeth is associated with chronic obstructive pulmonary disease (COPD) in a representative sample of Korean adults. Data from 3,107 subjects who participated in the 2009 Korea National Health and Nutrition Examination Survey were examined. The dependent variable was COPD and the independent variable was the number of existing permanent teeth. Spirometry results were classified into three groups (normal pattern, restrictive pattern, and obstructive pattern) by trained technicians. We used dichotomized COPD variables (no vs. yes). The number of existing permanent teeth was evaluated by oral examination and divided into 3 groups (0~19, 20~27, and 28). Demographic factors (age group and sex group), socioeconomic status (education and income), health behaviors (smoking and drinking), oral health and behavior (frequency of toothbrushing; periodontitis; decayed, missing, filled, permanent teeth index; and denture status), and general health status (body mass index, diabetes mellitus, and hypertension) were included as confounders in the analysis. Bivariate analysis and multivariate logistic regression analyses including confounders were applied, and all analyses considered a complex sampling design. Stratified analysis was performed by smoking status. After controlling for various confounders, there was a significant association between the number of existing permanent teeth and COPD (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.20~3.00 for the 20~27 group; OR, 3.93; 95% CI, 1.75~8.84 for the 0~19 group). The association was more significant in current smokers (OR, 8.90; 95% CI, 2.53~31.33). Our data indicate that the number of existing permanent teeth was independently associated with COPD, especially in current smokers. Further longitudinal research is needed to determine whether oral health promotion plays a role in the improvement of lung function and prevention of COPD.

Improvement of Radar Rainfall Estimation Using Radar Reflectivity Data from the Hybrid Lowest Elevation Angles (혼합 최저고도각 반사도 자료를 이용한 레이더 강우추정 정확도 향상)

  • Lyu, Geunsu;Jung, Sung-Hwa;Nam, Kyung-Yeub;Kwon, Soohyun;Lee, Cheong-Ryong;Lee, Gyuwon
    • Journal of the Korean earth science society
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    • v.36 no.1
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    • pp.109-124
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    • 2015
  • A novel approach, hybrid surface rainfall (KNU-HSR) technique developed by Kyungpook Natinal University, was utilized for improving the radar rainfall estimation. The KNU-HSR technique estimates radar rainfall at a 2D hybrid surface consistings of the lowest radar bins that is immune to ground clutter contaminations and significant beam blockage. Two HSR techniques, static and dynamic HSRs, were compared and evaluated in this study. Static HSR technique utilizes beam blockage map and ground clutter map to yield the hybrid surface whereas dynamic HSR technique additionally applies quality index map that are derived from the fuzzy logic algorithm for a quality control in real time. The performances of two HSRs were evaluated by correlation coefficient (CORR), total ratio (RATIO), mean bias (BIAS), normalized standard deviation (NSD), and mean relative error (MRE) for ten rain cases. Dynamic HSR (CORR=0.88, BIAS= $-0.24mm\;hr^{-1}$, NSD=0.41, MRE=37.6%) shows better performances than static HSR without correction of reflectivity calibration bias (CORR=0.87, BIAS= $-2.94mm\;hr^{-1}$, NSD=0.76, MRE=58.4%) for all skill scores. Dynamic HSR technique overestimates surface rainfall at near range whereas it underestimates rainfall at far ranges due to the effects of beam broadening and increasing the radar beam height. In terms of NSD and MRE, dynamic HSR shows the best results regardless of the distance from radar. Static HSR significantly overestimates a surface rainfall at weaker rainfall intensity. However, RATIO of dynamic HSR remains almost 1.0 for all ranges of rainfall intensity. After correcting system bias of reflectivity, NSD and MRE of dynamic HSR are improved by about 20 and 15%, respectively.

Oxidative Stress Induced Damage to Paternal Genome and Impact of Meditation and Yoga - Can it Reduce Incidence of Childhood Cancer?

  • Dada, Rima;Kumar, Shiv Basant;Chawla, Bhavna;Bisht, Shilpa;Khan, Saima
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.9
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    • pp.4517-4525
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    • 2016
  • Background: Sperm DNA damage is underlying aetiology of poor implantation and pregnancy rates but also affects health of offspring and may also result in denovo mutations in germ line and post fertilization. This may result in complex diseases, polygenic disorders and childhood cancers. Childhood cancer like retinoblastoma (RB) is more prevalent in developing countries and the incidence of RB has increased more than three fold in India in the last decade. Recent studies have documented increased incidence of cancers in children born to fathers who consume alcohol in excess and tobacco or who were conceived by assisted conception. The aetiology of childhood cancer and increased disease burden in these children is lin ked to oxidative stress (OS) and oxidative DNA damage( ODD) in sperm of their fathers. Though several antioxidants are in use to combat oxidative stress, the effect of majority of these formulations on DNA is not known. Yoga and meditation cause significant decline in OS and ODD and aid in regulating OS levels such that reactive oxygen speues meditated signal transduction, gene expression and several other physiological functions are not disrupted. Thus, this study aimed to analyze sperm ODD as a possible etiological factor in childhood cancer and role of simple life style interventions like yoga and meditation in significantly decreasing seminal oxidative stress and oxidative DNA damage and thereby decreasing incidence of childhood cancers. Materials and Methods: A total of 131 fathers of children with RB (non-familial sporadic heritable) and 50 controls (fathers of healthy children) were recruited at a tertiary center in India. Sperm parameters as per WHO 2010 guidelines and reactive oxygen species (ROS), DNA fragmentation index (DFI), 8-hydroxy-2'-deoxy guanosine (8-OHdG) and telomere length were estimated at day 0, and after 3 and 6 months of intervention. We also examined the compliance with yoga and meditation practice and smoking status at each follow-up. Results: The seminal mean ROS levels (p<0.05), sperm DFI (p<0.001), 8-OHdG (p<0.01) levels were significantly higher in fathers of children with RB, as compared to controls and the relative mean telomere length in the sperm was shorter. Levels of ROS were significantly reduced in tobacco users (p<0.05) as well as in alcoholics (p<0.05) after intervention. DFI reduced significantly (p<0.05) after 6 months of yoga and meditation practice in all groups. The levels of oxidative DNA damage marker 8-OHdG were reduced significantly after 3 months (p<0.05) and 6 months (p<0.05) of practice. Conclusions: Our results suggest that OS and ODD DNA may contribute to the development of childhood cancer. This may be due to accumulation of oxidized mutagenic base 8OHdG, and elevated MDA levels which results in MDA dimers which are also mutagenic, aberrant methylation pattern, altered gene expression which affect cell proliferation and survival through activation of transcription factors. Increased mt DNA mutations and aberrant repair of mt and nuclear DNA due to highly truncatred DNA repair mechanisms all contribute to sperm genome hypermutability and persistant oxidative DNA damage. Oxidative stress is also associated with genome wide hypomethylation, telomere shortening and mitochondrial dysfunction leading to genome hypermutability and instability. To the best of our knowledge, this is the first study to report decline in OS and ODD and improvement in sperm DNA integrity following adoption of meditation and yoga based life style modification.This may reduce disease burden in next generation and reduce incidence of childhood cancers.

History of the Korean Society of Applied Entomology for its First Fifty Years (한국응용곤충학회의 첫 50년 역사)

  • Boo, Kyung-Saeng
    • Korean journal of applied entomology
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    • v.51 no.2
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    • pp.171-190
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    • 2012
  • The Korean Society of Applied Entomology (KSAE) celebrates its First 50 years history this year, 2011. It began in the year 1962, as the Korean Society of Plant Protection (KSPP) to discuss all aspects of plant protection including entomology and plant pathology. At that time it was one of the earliest scientific ones among agricultural societies in Korea. Before liberation from the Japanese colonial rule there were a few scientific societies for Japanese scientists only in the Korean Peninsula. It seemed that there was a single exception, in medical field, formed by and operated for Korean ethnics. Right after the liberation, Korean scientists rushed to form new scientific societies in the fields of mechanical engineering, architecture, textile, internal medicine, biology, etc. in 1945, mathematics, chemistry, metallurgy, etc. in 1946, and so on. But agricultural scientists had to wait for more time before setting up their own scientific society, Korean Agricultural Society(韓國農學會), comprising all agricultural subfields, in 1954. They had annual meetings and published their own journal every year until 1962. Then those working in the plant protection field established their own KSPP, right after their section meeting in 1962. At that time the total number of participants for KSPP were only around 50. KSPP scientists were interested in plant pathology, agricultural chemicals, weed science, or bioclimate, besides entomology. They had annual meetings once or twice a year until 1987 and published their own journal, Korean Journal of Plant Protection (KJPP), once a year at the earlier years but soon gradually increasing the frequency to four times a year later. Articles on entomology and plant pathology occupied about 40% each, but the number of oral or posters were a little bit higher on plant pathology than entomology, with the rest on nematology, agricultural chemicals, or soil microarthropods. There also had a number of symposia and special lectures. The presidentship lasted for two years and most of president served only one term, except for the first two. The current president should be $28^{th}$. In the year 1988, KSPP had to be transformed into the applied entomology society, Korean Society of Applied Entomology (KSAE), because most of plant pathologists participating left the society to set up their own one, Korean Society of Plant Pathology in 1984. Since that time the Society concentrates on entomology, basic and applied, with some notes on nematology, acarology, soil microarthropods, agricultural chemicals, etc. The Society has been hosting annual meetings at least twice a year with special lectures and symposia, from time to time, on various topics. It also hosted international symposia including binational scientific meetings twice with two different Japanese (applied entomology in 2003 and acarology in 2009) societies and the Asia-Pacific Congress of Entomology in 2005. The regular society meeting of this year, 2011, turns out to be the 43rd and this autumn non-regular meeting would be the 42nd. It has been publishing two different scientific journals, Korean Journal of Applied Entomology (KJAE) since 1988 and the Journal of Asia-Pacific Entomology (JAPE) since 1998. Both journals are published 4 times a year, with articles written in Korean or English in the first, but those in English only in the latter with cooperation from the Taiwan Entomological Society and the Malaysian Plant Protection Society since 2008. It is now enlisted as one of those SCI(science citation index) extended. The highest number of topics discussed at their annual meetings was on ecology, behavior, and host resistance. But at the annual meetings jointly with the Korean Society of Entomology, members were more interested in basic aspects, instead of applied aspects, such as physiology and molecular biology fields. Among those societies related to entomology and plant protection, plant pathology, pesticide, and applied entomology societies are almost similar in membership, but entomology and plant pathology societies are publishing more number of articles than any others. The Society is running beautifully, but there are a few points to be made for further improvement. First, the articles or posters should be correctly categorized on the journals or proceedings. It may be a good idea to ask members to give their own version of correct category for their submissions, either oral or poster or written publication. The category should be classified detailed as much as possible (one kind of example would be systematics, morphology, evolution, ecology, behavior, host preference or resistance, physiology, anatomy, chemical ecology, molecular biology, pathology, chemical control, insecticides, insecticide resistance, biocontrol, biorational control, natural enemies, agricultural pest, forest pest, medical pest, etc.) and such scheme should be given to members beforehand. The members should give one or two, first and second, choices when submitting, if they want. Then the categories might be combined or grouped during editing for optimal arrangement for journals or proceedings. Secondly the journals should carry complete content of the particular year and author index at the last issue of that year. I would also like to have other information, such as awards and awardees in handy way. I could not find any document for listing awards. Such information or article categorization may be assigned to one of the vice presidents. I would rather strongly recommend that the society should give more time and energy on archive management to keep better and more correct history records.

Excessive Daytime Sleepiness Case Confounding with Thyrotoxicosis (과도한 주간 졸림과 탈력발작을 주소로 내원한 환자에서 발견된 갑상선 중독증)

  • Chung, Jae-Kyung;Kim, Eui-Joong
    • Sleep Medicine and Psychophysiology
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    • v.18 no.1
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    • pp.40-44
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    • 2011
  • Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/$m^2$. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 ${\mu}IU$/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 $^*0602$ type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatmen, and the cataplexy not supported by HLA DQB1 $^*0602$ should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.