Acute Lower Respiratory Tract Infections in Soldiers,South Korea,April 2011–March 2012

During April 2011–March 2012, we retrospectively reviewed medical records for South Korea soldiers to assess the etiology and epidemiology of acute viral lower respiratory tract infections. Adenovirus was the most commonly identified virus (63.2%) and the most common cause of pneumonia (79.3%) and hospitalization (76.6%); 3 soldiers died of adenovirus-related illness.     

Clinical Practice Guidelines for the Medical and Surgical Management of Primary Intracerebral Hemorrhage in Korea

The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH.     

The Usefulness of the Korean Version of Penn State Worry Questionnaire for Screening Generalized Anxiety Disorder: A Receiver Operating Characteristic Analysis

Objective

Excessive worry about minor matters and a state in which this worry is experienced as uncontrollable are known to be key symptoms of generalized anxiety disorder (GAD). Given the importance of pathological worry in GAD, the need for psychometrically sound measures of this construct has increased. The purpose of this study was to investigate the usefulness of the Korean version of Penn State Worry Questionnaire (K-PSWQ) for screening GAD.

Methods

Two hundred and forty six patients were initially screened, from which 102 GAD patients and 118 patients with anxiety disorder not otherwise specified (anxiety disorder NOS) were finally enrolled. Patients were diagnosed by a structured clinical interview for the DSM-IV Axis I. We also enrolled 114 control subjects who had no medical or psychiatric history. Pathological worry in both patients and control subjects were assessed at baseline using the PSWQ and we estimated optimal cutoff score by the receiver operating characteristic (ROC) analysis.

Results

We found that in the first ROC analysis, a score of 53 could simultaneously optimize sensitivity and specificity in order to discriminate GAD patients from control subjects. From the second receiver operating characteristic analysis, when both sensitivity and specificity were optimized, we can suggest a score of 61 as being the cutoff for differentiating GAD patients from patients with anxiety disorder NOS.

Conclusion

The Korean version of PSWQ is a useful method for screening GAD patients, although ethnic and cultural differences may affect the cutoff score of PSWQ for GAD.     

Types of social support and their relationships to physical and depressive symptoms and health-related quality of life in patients with heart failure

Objectives

To examine the various types of social support associated with physical and depressive symptoms and health-related quality of life (HRQOL) in patients with heart failure (HF) and the mediating effects of symptoms on the relationship between social support and HRQOL.

Background

Patients with HF have a high burden of physical and depressive symptoms, along with poor HRQOL. Social support may improve symptoms and HRQOL.

Methods

Data on social support (marital status, family relationships, relationships with health care providers, social networks, emotional support, and instrumental support), symptoms, and HRQOL were collected from 71 patients. Hierarchical regression was used to analyze the data.

Results

Emotional support was related to all physical and depressive symptoms and HRQOL. Physical and depressive symptoms mediated the relationship between emotional support and HRQOL.

Conclusions

Further studies are needed to identify ways to improve emotional support and determine whether the improvement leads to improvements in symptoms and HRQOL.     

Changes in Bone Mineral Density of Both Proximal Femurs after Total Knee Arthroplasty

Background

This study investigated the effects of total knee arthroplasty (TKA) on bone mineral density (BMD) of the proximal femur in patients who underwent the procedure.

Methods

Forty-eight patients scheduled to undergo unilateral TKA because of primary knee osteoarthritis were included in this study, which was conducted at a medical center between October 2006 and October 2009. In these 48 patients, 96 hips were evaluated. Measurement of BMD was performed preoperatively and one month, three months, six months, and one year after unilateral TKA. Repeated measured analysis of variance and paired t-tests for comparison of two repeated samples were used to compare differences between time points (preoperation, one, three, six, and 12 months) and between the operative and nonoperative sides.

Results

Preoperatively, BMD of the femoral neck, trochanter, and total hip on the operative side were lower than on the nonoperative side; however, there was no statistical difference. BMD of both femoral neck areas was significantly lower than preoperative BMD at one month and three months after TKA. BMD of both trochanter areas was significantly lower than preoperative BMD at one month and three months after TKA. BMD of both total hips was significantly lower than preoperative BMD at three months after TKA. However, no statistical differences of changes in BMD were observed between the operative and nonoperative sides at each measurement time.

Conclusions

According to our results, TKA was found to affect both proximal femurs during the acute period. However, TKA did not affect a change in BMD of the proximal femur during one year postoperative.     

Serum SPARC and Matrix Metalloproteinase-2 and Metalloproteinase-9 Concentrations after Bariatric Surgery in Obese Adults

Background

Remodeling of the extracellular matrix (ECM) of adipose tissue is regarded as part of the pathophysiology of obesity. Secreted protein acidic and rich in cysteine (SPARC) was the first ECM protein described in adipose tissue. Matrix metalloproteinases (MMPs) also play a role in ECM remodeling, and MMP-2 and MMP-9 may be associated with abnormal ECM metabolism. Here, we investigated changes in serum SPARC, MMP-2, and MMP-9 concentrations after bariatric surgery in obese adults.

Methods

We recruited 34 obese patients who were scheduled to undergo bariatric surgery for weight loss. We analyzed changes in serum SPARC, MMP-2, and MMP-9 concentrations before and 9 months after bariatric surgery and any associations between changes in SPARC, MMP-2, and MMP-9 concentrations and obesity-related parameters.

Results

Serum leptin levels significantly decreased, and the serum adiponectin level significantly increased after bariatric surgery. The serum SPARC concentration decreased significantly from 165.0?±?18.2 to 68.7?±?6.7 ng/mL (p?<?0.001), and the MMP-2 concentration also decreased significantly from 262.2?±?15.2 to 235.9?±?10.5 ng/mL (p?<?0.001). Changes in the serum SPARC concentration were significantly correlated with HOMA-IR changes, and changes in the serum MMP-9 concentration were found to inversely correlate with serum adiponectin changes.

Conclusion

These findings show that significant decreases in serum SPARC and MMP-2 concentrations occur after bariatric surgery. Our results thus suggest that weight loss via bariatric surgery could alter the ECM environment, and that these changes are related to certain metabolic changes.     

Surgical completeness of robotic thyroidectomy: a prospective comparison with conventional open thyroidectomy in papillary thyroid carcinoma patients

Background

Using the da Vinci^® robotic system, surgeons can complete secure thyroidectomy without noticeable neck scarring. This study compared the surgical completeness of transaxillary robotic thyroidectomy (RT) with conventional open procedures (OT) in treating papillary thyroid carcinoma (PTC) patients.

Materials and methods

From April 2009 through February 2011, 94 PTC patients underwent total thyroidectomy with central compartment neck dissection (CCND) at Yonsei University College of Medicine. All patients received 1.1 GBq radioactive iodine (RAI) ablation, post-therapy whole-body scans (TxWBS), and diagnostic WBS (DxWBS) 1 year later. We prospectively compared patient clinicopathologic characteristics and surgical completeness between the two groups.

Results

Fifty-one patients underwent OT and 43 underwent RT. Mean age was significantly younger in the RT group. Tumor size, capsular-invasion frequency, multifocality, bilaterality, and central nodal metastasis were not different between the two groups. The number of retrieved nodes during CCND did not significantly differ between the groups. There was no significant difference between the OT and RT groups in stimulated thyroglobulin levels acquired during TxWBS and DxWBS. The RAI uptake ratios at TxWBS were significantly higher in the RT group compared with the OT group; however, follow-up DxWBS showed no difference in RAI uptake ratios. Also, the ablation success rate was similar between the two groups. There were no abnormal findings in follow-up neck ultrasonography in either group.

Conclusion

Remnant thyroid tissue ablation after transaxillary RT was successfully managed by 1.1 GBq RAI. RT showed similar surgical completeness versus conventional OT, and provides a safe and feasible surgical option for PTC patients.     

Low-dose-rate radiation exposure leads to testicular damage with decreases in DNMT1 and HDAC1 in the murine testis

This study examined the effects of continuous low-dose-rate radiation exposure (3.49 mGy/h) of gamma rays on mice testicles. C57BL/6 mice were divided into sham and radiation groups (n = 8 each), and were exposed to either sham irradiation or 2 Gy for 21 days, 0.2 Gy for 2 days, or 0.02 Gy for 6 h of low-dose-rate irradiation. Testicular weight, seminiferous tubular diameter, and seminiferous epithelial depth were significantly decreased in the mice irradiated with 2 Gy at 1 and 9 days after exposure. Moreover, the low-dose-rate radiation exposure induced an increase in malondialdehyde levels, and a decrease in superoxide dismutase activity in the testis of mice irradiated with 2 Gy at 1 and 9 days after exposure. The sperm count and motility in the epididymis also decreased in mice irradiated with 2 Gy at 1 and 9 days after exposure, whereas there was no significant effect on the proportion of abnormal sperm. The expressions of DNA methlytransferases-1 and histone deacetylases 1 in testes irradiated with 2 Gy were significantly decreased compared with the sham group. In conclusion, the damage exerted on the testes and epididymis largely depended on the total dose of low-dose-rate radiation.