This study presents the development and validation of a risk assessment program of highly pathogenic avian influenza (HPAI). This program was developed by the Korean government (Animal and Plant Quarantine Agency) and a private corporation (Korea Telecom, KT), using a national database (Korean animal health integrated system, KAHIS).

Achalasia is a motility disorder of the esophagus characterized by absence of peristalsis and failure of relaxation of lower esophagus sphincter. The introduction of high resolution manometry (HRM) and per-oral endoscopic myotomy (POEM) has made a new chapter in diagnosis and treatment of achalasia. HRM allows classify according to the subtype of achalasia, and help predict prognosis and therapeutic response. POEM is a minimally invasive, effective option for treating achalasia. The management of achalasia required tailored application of various therapies such as botox injection, pneumatic balloon dilatation, POEM, or Heller's myotomy. In this review, we state the important aspects of diagnosis as well as management of achalasia.
Consensus ; Diagnosis ; Dilatation ; Esophageal Achalasia ; Esophagus ; Manometry ; Peristalsis ; Prognosis ; Relaxation

Achalasia is a motility disorder of the esophagus characterized by absence of peristalsis and failure of relaxation of lower esophagus sphincter. The introduction of high resolution manometry (HRM) and per-oral endoscopic myotomy (POEM) has made a new chapter in diagnosis and treatment of achalasia. HRM allows classify according to the subtype of achalasia, and help predict prognosis and therapeutic response. POEM is a minimally invasive, effective option for treating achalasia. The management of achalasia required tailored application of various therapies such as botox injection, pneumatic balloon dilatation, POEM, or Heller's myotomy. In this review, we state the important aspects of diagnosis as well as management of achalasia.
Consensus ; Diagnosis ; Dilatation ; Esophageal Achalasia ; Esophagus ; Manometry ; Peristalsis ; Prognosis ; Relaxation

The importance of adopting healthy exercise routines has been repeatedly emphasized to individuals with diabetes mellitus (DM). However, knowledge about the risk of exercise-induced hypoglycemia is limited. Regular exercise reduces and delays the onset of DM-related complications particularly in individuals who already have DM. However, an excessive exercise can lead to hypoglycemia. Excessive exercise in the evening can cause hypoglycemia while sleeping. Furthermore, if individuals with DM want to have a greater amount of exercise, the exercise duration rather than intensity must be increased. In weight resistance exercises, it is beneficial to first increase the number of repetitions, followed by the number of sets and gradually the weight of resistance. When performing intermittent high-intensity training within a short time period, hypoglycemia may develop for an extended period after exercise. In addition to adjusting exercise regimens, the medication doses must be modified accordingly. Delaying exercise, adjusting the number of snacks consumed prior to exercise, reducing insulin dose before exercise, and injecting insulin into the abdomen rather than the limbs prevent exercise-induced hypoglycemia prior to a spontaneous exercise. Ultimately, with personal knowledge on how to prevent hypoglycemia, the effects of exercise can be maximized in individuals with DM, and a healthy lifestyle can prevent future complications.

The importance of adopting healthy exercise routines has been repeatedly emphasized to individuals with diabetes mellitus (DM). However, knowledge about the risk of exercise-induced hypoglycemia is limited. Regular exercise reduces and delays the onset of DM-related complications particularly in individuals who already have DM. However, an excessive exercise can lead to hypoglycemia. Excessive exercise in the evening can cause hypoglycemia while sleeping. Furthermore, if individuals with DM want to have a greater amount of exercise, the exercise duration rather than intensity must be increased. In weight resistance exercises, it is beneficial to first increase the number of repetitions, followed by the number of sets and gradually the weight of resistance. When performing intermittent high-intensity training within a short time period, hypoglycemia may develop for an extended period after exercise. In addition to adjusting exercise regimens, the medication doses must be modified accordingly. Delaying exercise, adjusting the number of snacks consumed prior to exercise, reducing insulin dose before exercise, and injecting insulin into the abdomen rather than the limbs prevent exercise-induced hypoglycemia prior to a spontaneous exercise. Ultimately, with personal knowledge on how to prevent hypoglycemia, the effects of exercise can be maximized in individuals with DM, and a healthy lifestyle can prevent future complications.

OBJECTIVES: The dream recall and sleep of patients with rapid eye movement sleep behavior disorder (RBD) were not sufficiently studied. We hypothesized that RBD patients have frequent dream recall with poor sleep quality, and investigated the relationship between the dream recall frequency and sleep quality in RBD patients compared to controls. METHODS: We analyzed 81 drug naïve patients [RBD (+), 64.6±8.3 y, 57 males] and 81 age and gender matched patients with sleep disturbances without RBD [RBD (−), 63.7±7.3 y, 57 males]. All completed Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), Epworth sleepiness scale and Beck depression inventory. The 5-point rating scale was used to categorize dream recall frequency of most recent month (0=never, 4=very frequent). RESULTS: In RBD (+), dream recall frequency was much higher [frequent dreaming, 77.2% vs. 35.4%], and subjective sleep quality was much better [PSQI, 6.36±3.26 vs. 8.71±4.69]. Insomnia severity was much less in RBD (+) (ISI, 9.13±5.86) than RBD (−) (12.43±7.62). No significant differences were found in sleep parameters except lower N2 sleep % in RBD (+). The relationship between dream recall frequency and sleep was not significant in RBD (+), yet, a positive correlation was noted in RBD (−). CONCLUSIONS: RBD (+) had better sleep quality despite higher frequency of dream recall compared to RBD (−). Also dream recall was not related to their sleep quality in RBD (+), which suggests that RBD patients may have different sleep perception about their sleep and sleep quality.
Depression ; Dreams ; Humans ; REM Sleep Behavior Disorder ; Sleep Initiation and Maintenance Disorders ; Sleep, REM

Lung isolation in a neonate can be a challenge for the anesthesiologist. We report on our anesthetic experience with a neonate who had giant bronchopulmonary sequestration (BPS). The BPS was large enough to shift the mediastinum to the contralateral hemithorax. The trachea was immediately intubated after delivery and the lungs were mechanically ventilated in the neonatal intensive care unit. To prevent desaturation during the attempt of lung isolation, a 3 Fr Fogarty catheter was inserted into the trachea alongside the endotracheal tube without extubation. A fiberscope was then passed through the blocker port of a multiport adapter instead of the bronchoscopy port to minimize leakage by tightening the Touhy-Borst valve. Hypoxemia or leakage did not occur during the procedure. For early extubation, we provided caudal analgesia with ropivacaine and morphine. The giant BPS was successfully resected and the neonate was in excellent condition for early extubation. However, reintubation was needed for the pneumothorax caused by the inadequate placement of a chest drain 9 hours after extubation.
Amides ; Analgesia ; Analgesia, Epidural ; Anoxia ; Bronchopulmonary Sequestration ; Bronchoscopy ; Catheters ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Lung ; Mediastinum ; Morphine ; One-Lung Ventilation ; Pneumothorax ; Thorax ; Trachea

OBJECTIVES: The aim of this study was to determine whether children with Tourette disorder (TD) have functional impairment and executive dysfunction in comparison to children with attention-deficit hyperactivity disorder (ADHD) and non-affected controls. METHODS: From January 2006 to December 2013, 45 children and adolescents with TD and 50 children and adolescents with ADHD diagnosed at the Soonchunhyang University Bucheon Hospital and 50 non-affected controls were enrolled in this study. Functional impairment of the subjects was assessed using the Child and Adolescents Functioning Impairment Scale (CAFIS), parent and teacher versions. In addition, neuropsychological tests including Stroop color-word Test, Finger windows Test (FWT), and Digit span were administered. Outcomes were compared across the TD, ADHD, and non-affected controls. RESULTS: No difference in CAFIS-parent and CAFIS-teacher results was observed between children with TD and non-affected controls, whereas, children with ADHD showed more impairments relative to non-affected controls in the CAFIS-parent. According to the Stroop color-word Test, FWT, and Digit span, executive function in children with TD did not differ from non-affected controls. Children with ADHD had poorer performance in measures of the Stroop color-word Test compared to children with TD. CONCLUSION: Children and adolescents with TD but not ADHD were not significantly different from non-affected controls on most measures of functional impairment and executive function. These findings suggest that an education program and intervention for children with TD would be important to reducing the stigma of TD.
Adolescent ; Child* ; Education ; Executive Function ; Fingers ; Gyeonggi-do ; Humans ; Neuropsychological Tests ; Parents ; Tourette Syndrome*

BACKGROUND: Metabolic syndrome (MetS) is characterized by a core set of disorders, including abdominal obesity, dyslipidemia, glucose intolerance and hypertension. Many studies have shown that MetS is associated with increased risk of developing cardiovascular diseases and related mortality. However, the relationship of MetS with early stage of cardiovascular diseases, which is even more important from a prevention prespective, has not been examined extensively. Brachial-ankle pulse wave velocity (baPWV) is known to predict future cardiovascular events. Thus, we examined the relationship of MetS, defined using the NCEP-ATP III criteria, with baPWV. METHODS: We examined a total of 400 participants who did not have a past history of either coronary heart disease or peripheral vascular disease. All subjects underwent physical examination, blood chemistry, and baPWV. RESULTS: Compared with subjects without MetS, subjects with MetS had increased age, body mass index (BMI), and ALT. Mean value of baPWV (adjusted for age, BMI, and blood pressure) was significantly higher in subjects with MetS (P=0.002). The baPWV was positively correlated with age, BMI, systolic and diastolic blood pressure in subjects with MetS. In group without MetS, the baPWV was associated with age, waist circumference, blood pressure, total cholesterol, LDL cholesterol, triglyceride, fasting blood sugar, AST, ALT, homocysteine, CRP, and ferritin. The mean values of baPWV with 0, 1, 2, 3, 4, 5 components of MetS were 1,362.3+/-182.2 cm/s, 1,531.3+/-267.0 cm/s, 1,694.1+/-315.8 cm/s, 1,777.0+/-334.0 cm/s, 2,087.7+/-192.3 cm/s, respectively. CONCLUSION: In this study, the MetS was associated with the risk for increased baPWV.
Ankle* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Chemistry ; Cholesterol ; Cholesterol, LDL ; Coronary Disease ; Dyslipidemias ; Fasting ; Ferritins ; Glucose Intolerance ; Homocysteine ; Hypertension ; Mortality ; Obesity, Abdominal ; Peripheral Vascular Diseases ; Physical Examination ; Pulse Wave Analysis* ; Triglycerides ; Waist Circumference

BACKGROUND: Metabolic syndrome (MetS) is characterized by a core set of disorders, including abdominal obesity, dyslipidemia, glucose intolerance and hypertension. Many studies have shown that MetS is associated with increased risk of developing cardiovascular diseases and related mortality. However, the relationship of MetS with early stage of cardiovascular diseases, which is even more important from a prevention prespective, has not been examined extensively. Brachial-ankle pulse wave velocity (baPWV) is known to predict future cardiovascular events. Thus, we examined the relationship of MetS, defined using the NCEP-ATP III criteria, with baPWV. METHODS: We examined a total of 400 participants who did not have a past history of either coronary heart disease or peripheral vascular disease. All subjects underwent physical examination, blood chemistry, and baPWV. RESULTS: Compared with subjects without MetS, subjects with MetS had increased age, body mass index (BMI), and ALT. Mean value of baPWV (adjusted for age, BMI, and blood pressure) was significantly higher in subjects with MetS (P=0.002). The baPWV was positively correlated with age, BMI, systolic and diastolic blood pressure in subjects with MetS. In group without MetS, the baPWV was associated with age, waist circumference, blood pressure, total cholesterol, LDL cholesterol, triglyceride, fasting blood sugar, AST, ALT, homocysteine, CRP, and ferritin. The mean values of baPWV with 0, 1, 2, 3, 4, 5 components of MetS were 1,362.3+/-182.2 cm/s, 1,531.3+/-267.0 cm/s, 1,694.1+/-315.8 cm/s, 1,777.0+/-334.0 cm/s, 2,087.7+/-192.3 cm/s, respectively. CONCLUSION: In this study, the MetS was associated with the risk for increased baPWV.
Ankle* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Chemistry ; Cholesterol ; Cholesterol, LDL ; Coronary Disease ; Dyslipidemias ; Fasting ; Ferritins ; Glucose Intolerance ; Homocysteine ; Hypertension ; Mortality ; Obesity, Abdominal ; Peripheral Vascular Diseases ; Physical Examination ; Pulse Wave Analysis* ; Triglycerides ; Waist Circumference