• Genomics & Informatics
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• v.16 no.2
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• pp.36-41
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• 2018

Kawasaki disease (KD) is an acute febrile vasculitis predominately affecting infants and children. The dominant incidence age of KD is from 6 months to 5 years of age, and the incidence is unusual in those younger than 6 months and older than 5 years of age. We tried to identify genetic variants specifically associated with KD in patients younger than 6 months or older than 5 years of age. We performed an age-stratified genome-wide association study using the Illumina HumanOmni1-Quad BeadChip data (296 cases vs. 1,000 controls) and a replication study (1,360 cases vs. 3,553 controls) in the Korean population. Among 26 candidate single nucleotide polymorphisms (SNPs) tested in replication study, only a rare nonsynonymous SNP (rs4365796: c.1106C>T, p.Thr369Met) in the lymphoid enhancer binding factor 1 (LEF1) gene was very significantly associated with KD in patients younger than 6 months of age (odds ratio [OR], 3.07; $p_{combined}=1.10{\times}10^{-5}$), whereas no association of the same SNP was observed in any other age group of KD patients. The same SNP (rs4365796) in the LEF1 gene showed the same direction of risk effect in Japanese KD patients younger than 6 months of age, although the effect was not statistically significant (OR, 1.42; p = 0.397). This result indicates that the LEF1 gene may play an important role as a susceptibility gene specifically affecting KD patients younger than 6 months of age.

• Journal of Gastric Cancer
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• v.5 no.2
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• pp.95-100
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• 2005

Purpose: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. Materials and Methods: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. Results: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the $7^{th}$ postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was $7.7\%$ (2/26), and the variance rate was $30.8\%$ (8/26). The mean hospital stay was 11.3 days ($10\~15$ days) for the CP group compared with 17.5 days ($9\∼68$ days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days ($7\∼68$ days) and 8.3 days ($7\∼12$ days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group ( $\\$ 6,292,200) than in the CP group ( $\\$ 4,863,685). The charge per hospital day was higher in the CP group ( $\\$ 430,414) than in the non-CP group ( $\\$ 359,554). Patient satisfaction was higher in the CP group than in the non-CP group. Conclusion: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.

• Korean Journal of Biological Psychiatry
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• v.22 no.4
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• pp.187-194
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• 2015

Objectives To examine direct causes of attempted suicides, methods adopted to commit suicide, and psychiatric diagnoses among suicide attempters in South Korea. Methods A total of 1359 suicide attempters who had visited emergency department of 17 medical centers due to suicide attempt from May 2013 to Nov 2013 were interviewed using semi-structured questionnaires. Results Psychiatric symptoms were the most common cause of suicide attempts (62.2%), followed by interpersonal relationships (24.4%). Women attempted suicide more often for interpersonal reasons, whereas men were more likely to do so for financial and job-related reasons. Half of participants (55.8%) attempted suicide by drug intoxication, which was more prevalent among females and those who had previous history of psychiatric disease or previous suicide attempt. Men were more likely to use more lethal methods such as pesticide poisoning and gas inhalation than women. Pesticide poisoning was also prevalent among the elderly group and the rural population. Near ninety-five percent (94.5%) of participants received a psychiatric diagnosis : the most frequent diagnosis was depressive disorder. Conclusions This is the first nationwide study of cases of attempted suicide. When stratified by age groups, gender, urbanicity, living alone or not, presence of physical illness, previous psychiatric history, and previous suicide attempt, there were significant differences with respect to causes, methods of attempted suicides and psychiatric diagnoses of suicide attempters.

• Clinical and Experimental Reproductive Medicine
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• v.36 no.2
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• pp.121-127
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• 2009

Objective: To investigate the prevalence, the distribution of deciduosis, and the relationship with endometriosis in fertile women during Cesarean delivery. Methods: In this study, pelvic tissues suspicious for ectopic deciduas were taken for biopsy during Cesarean section from 154 parturients of full term pregnancy from January 1990 to December 2003. And then those patients were followed up till April 2008. Results: Tissues from 94 parturients (94/154, 61%) were evaluated histopathologically, and ectopic decidua was observed in 70.2% (66/94). Ectopic sites were ovaries only (65/94, 69.1%), ovaries and uterine serosa (12/94, 12.8%), uterine serosa only (9/94, 9.6%), and pelvic serosa. Twenty seven (27/66, 40.9%) parturients had past history of diagnosis and treatments for endometriosis. We have tried to connect 39 (39/66, 59.1%) patients who had never been diagnosed for endometriosis but pathologically confirmed for deciduosis, and 18 patients were able to contact by phone. Twelve patients (12/18, 66.6%) showed no symptoms of endometriosis and had not received any treatments for endometriosis. Conclusion: We can conclude that most of incidental cases confirmed pathologically for deciduosis during pregnancy do not symptomatically progress.

• Journal of Hospice and Palliative Care
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• v.5 no.2
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• pp.125-135
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• 2002

Purpose : The purpose of this study was to investigate the impact of depression, discomfort, spirituality, physical care, and opioid use on pain with terminally ill cancer patients in the hospice units. Method : The convenient sample of this study consisted of 58 terminally ill cancer patients at three hospice units in university-affiliated hospitals. Patients were interviewed with structured questionnaires. The data was analyzed using ANOVA, Pearson correlation coefficient, and multivariate multiple regression. Result : The results of this study were as follows : 1) The mean age of the participants was approximately 57 years. Regarding diagnosis, stomach cancer showed the highest frequency (24.1%), followed by lung cancer (17.2%) and rectal cancer (13.8%). Regarding motivation for admission to the hospice unit, the majority of the participants indicated pain control (67.2%), followed by spiritual care (39.7%), and symptom relief (27.6%). 2) The mean pain level measured by VAS was 5.13 (${\pm}2.61$). Regarding pain type, the highest pain frequency the participants experienced was deep pain (53.4%), followed by multiple pain (20.7%), intestinal pain (17.3%), and neurogenic (5.2%) and superficial pain (3.4%). 3) Regarding the factors influencing pain, the pain level was significantly affected by the depression level (P<0.01) and the opioid use (P<0.01). Conclusion, In summary, the higher the level of pain the terminally ill cancer patents had the higher the depression level as well as the opioid use. Thus, health care professionals need to continuously provide holistic care for them to die comfortably.

• Journal of Hospice and Palliative Care
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• v.18 no.2
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• pp.120-127
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• 2015

Purpose: We aimed to investigate how serum vitamin D levels are related to survival of terminally ill cancer patients. Methods: From May 2012 through June 2013, a retrospective chart review was performed on 96 hospice patients. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with severe vitamin D deficiency and Coxcy and Coxional hazard analyses were used to evaluate effects on survival. Results: The mean vitamin D level in patients was $8.60{\pm}7.16ng/ml$. Vitamin D was severely deficient (<10 ng/ml) in 75 patients (78.2%), deficient (10~20 ng/ml) in 13 patients (13.5%), relatively insufficient (21~29 ng/ml) in five patients (8.3%) and sufficient ((t ng/ml) in three patients (3.1%). Hyperbilirubinemia (${\geq}1.2g/dl$) was the only factor associated with severe vitamin D deficiency according to the multiple logistic regression analysis (Odds ratio, OR=18.48, P<0.05). Although hyperbilirubinemia showed a strong association with survival (Hazard ratio, HR=2.25, P<0.01), no association was found between severe vitamin D deficiency and survival (HR=1.15, P>0.05) in Cox's proportional hazard analysis. Conclusion: Although serum vitamin D levels were severely low in terminally ill cancer patients, we found no association between severe vitamin D deficiency and patient survival.

• Pediatric Infection and Vaccine
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• v.26 no.3
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• pp.148-160
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• 2019

Purpose: This study aimed to investigate the molecular epidemiology of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak at a newborn nursery and neonatal intensive care unit (NICU). Methods: During the outbreak, from August to September 2017, MRSA isolates collected from neonates and medical staff underwent genotyping and screened for virulence factors. Antibiotic susceptibilities were tested. Results: During the study period, 41 neonates were admitted at the nursery (n=27) and NICU (n=14). Of these, 7 had MRSA infections (skin infection [n=6] and sepsis [n=1]) and 4 were colonized with MRSA. Associated medical staff (n=32) were screened; three were nasal MRSA carriers. Staphylococcal chromosomal cassette mec (SCCmec) type II, sequence type (ST) 89, spa type t375 was found to be the skin infection outbreak causing strain, with multi-drug resistance including low-level mupirocin resistance. SCCmec type IVa, ST 72, and a novel spa type designated t17879, was the cause of MRSA sepsis. Many different types of MRSA were colonized on the neonates; however, SCCmec type IVa, ST 72, spa type t664 was colonized in both neonates and a NICU nurse. All MRSA isolates from colonized infants were positive for the Panton-Valentine leukocidin (PVL) toxin gene. Conclusions: The strain causing an outbreak of skin infections had multi-drug resistance. Also, MRSA colonized in the neonates were found to carry the PVL toxin gene. Because different strains are present during an outbreak, molecular epidemiologic studies are important to identify the outbreak strain and colonized strains which aid in effective control and prevention of future MRSA outbreaks.

• Tuberculosis and Respiratory Diseases
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• v.62 no.6
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• pp.479-485
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• 2007

Background: The purpose of this study was to evaluate the differences in CT findings according to sputum smear-positive or -negative results in patients with active pulmonary tuberculosis having a single cavity. Methods: A total of 32 patients with active pulmonary tuberculosis having a single cavity on CT were classified into two groups: smear-positive (n=19) and smear-negative (n=13). The CT findings were reviewed retrospectively. The presence of consolidation, the number of lobes showing consolidation, ground-glass opacity, micronodules and nodule, the maximum diameter of the cavity, and the shape and maximum thickness of the cavity wall were assessed. Result: The maximum diameter of the cavity was $33.84{\pm}13.65mm$ and $27.08{\pm}9.04mm $ in the smear-positive and -negative groups, respectively (p>0.05). The amount of consolidation and the number of lobes with consolidation were found to be 89.5% and 30.8% (p=0.01) and $1.37{\pm}0.90$ and $0.31{\pm}0.48$ (p=0.0002) in the smear-positive and -negative groups, respectively. Consolidations in two or more lobes were only noted in 31.6% of in the sputum smear- positive group (p< 0.05). There were no other significant differences between the two groups. The sensitivity, specificity, positive and negative predictive values for the presence of consolidation were 89.5%, 69.2%, 73.9%, and 81.8%, respectively. Conclusion: While the absence of consolidation on CT may be associated with sputum smear-negative results in patients with active pulmonary tuberculosis having a single cavity, the presence of consolidation in two or more lobes on CT may be associated with spear-positive results in these patients.

• Journal of agricultural medicine and community health
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• v.31 no.1
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• pp.1-8
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• 2006

Objectives: We studied to find out the relevant relationship between the type of residence and the level of mental depression among aged people. Methods: The authors surveyed 156 people who are over 65 in a small city. Here are three groups: 50 persons who live in the facility for the aged. 72 persons who live with their family and 34 persons who live alone. We developed the questionnaire and the severity of depressive symptoms was measured using Korean Form of Geriatric Depression Scale (KGDS) score. Results: Positive rate of depressive disorders among the aged people was 43.6%. Positive rate of depressive disorders among the aged who live in the facility for the aged was 42.0% and that persons who live with their family was 9.7%. It's more likely to be their gender, the marital status, schooling, going out and pocket money that affect on their mental depression. According to the multiple logistic regression, the odds ratios of the persons who live in the facility for the aged versus persons who live with their family and pocket money in a month were significant (p<0.05). Conclusions: The research shows that the mental depression in the aged people is more serious in the facility for the aged and also significantly related to their pocket money.

• Korean Journal of Adult Nursing
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• v.12 no.2
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• pp.234-244
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• 2000

It is widely recognized that manipulation of body position takes advantage of the influences of gravity for improving oxygenation. The study aims to determine the effects of positioning(supine, prone, right lateral decubitus and left lateral decubitus positions) applied to the mechanically ventilatory acute respiratory failure patients on arterial oxygen partial pressure($PaO_2$), alveolar arterial oxygen tension difference($AaDO_2$), mean aterial pressure, peak inspiratory pressure and plateau pressure. Thirty two acute respiratory failure patients admitted to the medical intensive care unit at Kangnam St. Mary's Hospital, The Catholic University of Korea from March 1997 to January 1998, were divided into three groups by radiographic evidence of unilateral or bilateral lung disease. In group 1 with dominant right lung disease were twelve subjects, group 2 with dominant left lung disease had eight subjects and group 3 had twelve subjects with bilateral lung disease. The variables were measured in 30 minutes after each position of supine, prone, good lung down lateral decubitus and sick lung down lateral decubitus position. The position order was done at random by Latin squre design. The results are as follows; 1) With group 1 patients, the $PaO_2$ in the left lateral decubitus and prone position were $126.8{\pm}30.8$ mmHg and $106.7{\pm}36.8$ mmHg, respectively(p=0.0001). 2) With group 2 patients, the $PaO_2$ in the prone and the right lateral decubitus position were $121.7{\pm}44.7$ mmHg and $118.5{\pm}31.7$ mmHg, respectively (p=0.0018). 3) With group 3 patients, the $PaO_2$ was $143.6{\pm}36.6$ mmHg in the prone position (p=0.0001). 4) With group 1 patients, the $AaDO_2$ in the left lateral decubitus and the right lateral decubitus position were $178.1{\pm}29.7$ mmHg and $233.1{\pm}24.4$ mmHg, respectively(p=0.0001). 5) With group 2 patients, the $AaDO_2$ in the prone and the left lateral decubitus postion were $184.0{\pm}39.5$ mmHg and $231.0{\pm}23.9$ mmHg, respectively(p=0.0019). 6) With group 3 patients, the $AaDO_2$ in the prone and the supine postion were $377.1{\pm}35.6$ mmHg and $435.7{\pm}13.1$ mmHg, respectively (p=0.0001). 7) There were no differences among the mean arterial pressure, peak inspiratory pressure and plateau pressure for each of the supine, prone, left lateral decubitus and right lateral decubitus position. The results suggest that oxygenation may improve in mechanically ventilatory patients with unilateral lung disease when the position is good lung dependent and prone, and patients with bilateral lung disease when the position is prone without any effects on the mean arterial pressure and airway pressure. It is suggested that body positions improve ventilation/perfusion matching and oxygenation need to be specified in patient care plans.