OBJECTIVES: The effect of mercury on the cardiovascular system has recently been reported on, but the mechanisms as well as its nature of this effect still need to be confirmed. In this study, the mercury in the hair of a community population was analyzed in relation to the cardiac autonomic activity. METHODS: A hair sample was obtained from the occiput area and the mercury in the hair was analyzed by using a Direct Mercury Analyzer. We measured the cardiovascular risk factors, including total cholesterol, triglyceride, blood pressure, and the body mass index (BMI). Heart rate variability was assessed for 5 minutes, in the time and frequency domain, by using SA-3000P from the Medi-core(R). company. The association between the mercury in the hair and heart rate variability was assessed after controlling for the other cardiovascular risk factors. RESULTS: The mean age of the 671 total subjects was 36 years. The geometric mean of the hair mercury was 0.90 ppm. The hair mercury level was elevated in males, adults, smokers and drinkers. Hair mercury and age, the systolic and diastolic blood pressure, total cholesterol, triglyceride, LDL cholesterol and BMI were all positively correlated. However, hair mercury and heart rate, HDL cholesterol, standard deviation of the NN intervals (SDNN), total power (TP), low-frequency (LF), high- frequency (HF) were negatively correlated. In the higher mercury group, heart rate, SDNN, LF and HF indices were significantly lower compared with those of the lower mercury group. Heart rate was decreased 2.6 beats/min, Ln (HF) was decreased 0.131 msec2 and HF norm was decreased 2.550 with a 1 ppm increase of Ln (Hg), according to multiple linear regression analysis after controlling for age, gender and other cardiovascular risk factors. CONCLUSION: This cross-sectional study showed that mercury may affect the cardiac autonomic activity through parasympathetic dysfunction.
Adult ; Autonomic Nervous System ; Blood Pressure ; Body Mass Index ; Cardiovascular System ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Cross-Sectional Studies ; Hair ; Heart ; Heart Rate ; Humans ; Linear Models ; Male ; Risk Factors

Cigarette smoking is the leading preventable cause of death, with smoking cessation representing the most effective strategy to reduce the risk of smoking-related diseases. Pharmacotherapeutic interventions for smoking cessation such as nicotine replacement therapy, bupropion, and varenicline aim to manage the symptoms of nicotine cravings and withdrawal. Evidence-based practice guidelines for pharmacotherapy in smoking cessation have been recently developed in Korea.Current Concepts: Among the general population, varenicline is the recommended first-line therapy for smoking cessation, surpassing nicotine patches and bupropion therapy. Although varenicline is commonly effective, combination therapy with varenicline and a nicotine patches may be considered when varenicline monotherapy is insufficient for managing nicotine cravings and withdrawal symptoms. Extended-duration therapy (>12 weeks) has demonstrated greater efficacy compared to standard therapy (6-12 weeks). Varenicline can promote attempts to quit smoking in smokers who are not yet prepared to quit. In cases of smokers with comorbid psychiatric conditions, varenicline is preferred over nicotine patches. The efficacy and safety profiles of smoking cessation medications have been well established in patients with cardiovascular diseases.Discussion and Conclusion: Smoking is a chronic condition associated with a high risk of relapse, emphasizing the crucial role of pharmacotherapy in increasing the success rates of smoking cessation. In accordance with evidence-based smoking cessation guidelines, the careful selection of pharmacotherapeutic agents tailored to individual smokers is pivotal.

BACKGROUND: The educational assessment of residents is very important in order to check their knowledge and to improve their ability. In case of family practice, the residents spend most of their training time in outside rotations with other specialities. Therefore, they are requested to be evaluated by each specialist after each rotation. To give more accurate assessment, we surveyed directly our family practice residents and family practice faculties. METHODS: A questionnaire was sent to family practice residents and family practice faculties in 116 hospitals from May to June 2006. The response rate was 29% and 78%, respectively. RESULTS: Among the total, 70.2% of family practice residents thought an assessment is necessary, but only 51.7% were evaluated. Overall, 90.4% of family practice faculties knew about the assessment of residents made by other specialists, and only 56.7% of faculties requested other specialists to assess their family practice residents. CONCLUSION: Most of the family practice residents and their faculties knew the need for assessment, but they complained there were no objectivity and the assessment tool was lacking. In order to solve this problem, it is urgent to develop a unified form and guidelines of assesment.
Educational Measurement* ; Equidae ; Family Practice* ; Humans ; Specialization ; Surveys and Questionnaires

BACKGROUND: This study was conducted to survey the current status of family medicine residency programs and to evaluate the difficulties in training of the curriculums. METHODS: Questionnaires on residency programs were sent to all the centers of residency programs by mail in April 2006. The questionnaire included detailed characteristics of residency programs, curriculum schedule, reasons for failed specific curriculum, and review and measures by the program center and the Korean Academy of Family Medicine to resolve problematic curriculums. RESULTS: A total of 113 residency programs responded. Among the 93 residency programs except for the 20 subsidiary hospitals, inadeguate subjects were mainly dermatology (12 programs, 12.3%), psychiatry (6 programs, 7.5%), ophthalmology (5 programs, 7.1%), and otolaryngology (5 programs, 7.1%). Training rejection rate was higher in dermatology (13 programs, 14.4%), radiology (11 programs, 13.1%), gastrofibroscopy (8 programs, 9.5%), and psychiatry (5 programs, 6.2%). Emergency me-dicine in 4 programs and general surgery in 3 programs had a longer duration of training than initially planned. Difficulties in training some subjects were due to failed establishment of specific curriculums in non-university hospital. Commonly established clinics were health promotion center, obesity clinic, smoking cessation clinic, geriatric clinic, stress clinic, and clinical nutrition clinic. Family medicine center programs included gastrofibroscopy, obesity, smoking cessation, geriatrics, hospice care, and evidence-based medicine. CONCLUSION: There is repeated demand for taking measures to promote better curriculum in the nation-wide view of family medicine. Dermatology, radiology, psychiatry, and otolaryngology were the subjects difficult to receive training. Measures to strengthen the weak subjects are urgently needed.
Appointments and Schedules ; Curriculum* ; Dermatology ; Emergencies ; Evidence-Based Medicine ; Geriatrics ; Health Promotion ; Hospice Care ; Humans ; Internship and Residency* ; Korea* ; Obesity ; Ophthalmology ; Otolaryngology ; Postal Service ; Smoking Cessation ; Surveys and Questionnaires

BACKGROUND: This study was conducted to survey the current status of family medicine residency programs and to evaluate the difficulties in training of the curriculums. METHODS: Questionnaires on residency programs were sent to all the centers of residency programs by mail in April 2006. The questionnaire included detailed characteristics of residency programs, curriculum schedule, reasons for failed specific curriculum, and review and measures by the program center and the Korean Academy of Family Medicine to resolve problematic curriculums. RESULTS: A total of 113 residency programs responded. Among the 93 residency programs except for the 20 subsidiary hospitals, inadeguate subjects were mainly dermatology (12 programs, 12.3%), psychiatry (6 programs, 7.5%), ophthalmology (5 programs, 7.1%), and otolaryngology (5 programs, 7.1%). Training rejection rate was higher in dermatology (13 programs, 14.4%), radiology (11 programs, 13.1%), gastrofibroscopy (8 programs, 9.5%), and psychiatry (5 programs, 6.2%). Emergency me-dicine in 4 programs and general surgery in 3 programs had a longer duration of training than initially planned. Difficulties in training some subjects were due to failed establishment of specific curriculums in non-university hospital. Commonly established clinics were health promotion center, obesity clinic, smoking cessation clinic, geriatric clinic, stress clinic, and clinical nutrition clinic. Family medicine center programs included gastrofibroscopy, obesity, smoking cessation, geriatrics, hospice care, and evidence-based medicine. CONCLUSION: There is repeated demand for taking measures to promote better curriculum in the nation-wide view of family medicine. Dermatology, radiology, psychiatry, and otolaryngology were the subjects difficult to receive training. Measures to strengthen the weak subjects are urgently needed.
Appointments and Schedules ; Curriculum* ; Dermatology ; Emergencies ; Evidence-Based Medicine ; Geriatrics ; Health Promotion ; Hospice Care ; Humans ; Internship and Residency* ; Korea* ; Obesity ; Ophthalmology ; Otolaryngology ; Postal Service ; Smoking Cessation ; Surveys and Questionnaires

A deficiency of the urea cycle enzyme, argininosuccinate synthetase which is produced in liver, makes citrullinemia, which is an autosomal recessive disorder. As the liver is the only organ which transforms ammonia into urea, liver transplantation has been considered as an effective alternative therapy to classical dietary and medical therapy. We have experienced perioperative anesthetic care for a 27-year-old male with citrullinemia undergoing successful living donor auxiliary partial orthotopic liver transplantation (APOLT). After the liver transplantation, the postoperative clinical courses of the patient were uneventful, and the neurological symptoms were completely resolved. The plasma concentrations of ammonia and citrulline normalized rapidly without any kinds of protein dietary restrictions. We present this case with a brief review of literature.
Adult ; Ammonia ; Argininosuccinate Synthase ; Citrulline ; Citrullinemia ; Humans ; Hyperammonemia ; Liver ; Liver Transplantation ; Living Donors ; Male ; Plasma ; Urea