Pancytopenia represents a unique challenge for primary care doctors and its etiological causes encompass various specialties, including hematology and rheumatology. Despite the existence of effective tests such as bone marrow biopsy and immunoassays to rule out the potential causes of pancytopenia, it is often difficult to pinpoint the exact diagnosis. In this case report, we have described such a ‘gray zone’ patient, who presented with pancytopenia, neutropenia, and splenomegaly, and was being treated for fungal pneumonia before being transferred to Severance Hospital (department of family medicine). As the patient had a 10-year history of multiple, long-term hospital admissions that were having a severely debilitating impact on the quality of life, we performed a partial splenic embolization as a potential cure for the symptoms. Although this induced acute blood count recovery, it failed to prevent eventual mortality from septic shock.

Pancytopenia represents a unique challenge for primary care doctors and its etiological causes encompass various specialties, including hematology and rheumatology. Despite the existence of effective tests such as bone marrow biopsy and immunoassays to rule out the potential causes of pancytopenia, it is often difficult to pinpoint the exact diagnosis. In this case report, we have described such a ‘gray zone’ patient, who presented with pancytopenia, neutropenia, and splenomegaly, and was being treated for fungal pneumonia before being transferred to Severance Hospital (department of family medicine). As the patient had a 10-year history of multiple, long-term hospital admissions that were having a severely debilitating impact on the quality of life, we performed a partial splenic embolization as a potential cure for the symptoms. Although this induced acute blood count recovery, it failed to prevent eventual mortality from septic shock.

BACKGROUND/OBJECTIVES: This study analyzed the quality of lunches provided in senior leisure service (SLS) facilities and compared institutional foodservice (IF) and noninstitutional foodservice (non-IF). SUBJECTS/METHODS: Data of 390 adults aged 65 years or older who ate lunches in SLS facilities were analyzed using the information from the 2013–2017 Korea National Health and Nutrition Examination Survey. The participants were classified into IF (n = 129) and non-IF (n = 261) groups according to meal type provided. The intake of major food groups, energy and nutrients, and nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) were analyzed. The diversity of meals was evaluated by food group patterns, dietary diversity score (DDS) and dietary variety score (DVS). Energy intake was adjusted in model 1, while energy and sex were adjusted in model 2. All confounding variables were adjusted in model 3. RESULTS: The intake of seafoods (P < 0.001 in models 1, 2, and 3), seaweeds (P < 0.01 in models 1 and 2), and dairy products (P < 0.05 in models 1, 2, and 3) was significantly higher in the IF group. No significant difference existed in energy intake; however, the intake of all nutrients except carbohydrate and vitamin C was significantly higher in the IF group. NAR of all nutrients, excluding vitamin C, was higher in the IF group, and MAR was also higher in the IF group (P < 0.001 in models 1, 2, and 3). The IF group had significantly higher DDS and DVS than the non-IF group (P < 0.001). CONCLUSIONS The lunches provided in SLS facilities were better in terms of quantity and quality when provided through IF than through non-IF. More systematic foodservice programs should be implemented in SLS facilities, especially in facilities wherein users prepare their own meals.

BACKGROUND/OBJECTIVES: This study analyzed the quality of lunches provided in senior leisure service (SLS) facilities and compared institutional foodservice (IF) and noninstitutional foodservice (non-IF). SUBJECTS/METHODS: Data of 390 adults aged 65 years or older who ate lunches in SLS facilities were analyzed using the information from the 2013–2017 Korea National Health and Nutrition Examination Survey. The participants were classified into IF (n = 129) and non-IF (n = 261) groups according to meal type provided. The intake of major food groups, energy and nutrients, and nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) were analyzed. The diversity of meals was evaluated by food group patterns, dietary diversity score (DDS) and dietary variety score (DVS). Energy intake was adjusted in model 1, while energy and sex were adjusted in model 2. All confounding variables were adjusted in model 3. RESULTS: The intake of seafoods (P < 0.001 in models 1, 2, and 3), seaweeds (P < 0.01 in models 1 and 2), and dairy products (P < 0.05 in models 1, 2, and 3) was significantly higher in the IF group. No significant difference existed in energy intake; however, the intake of all nutrients except carbohydrate and vitamin C was significantly higher in the IF group. NAR of all nutrients, excluding vitamin C, was higher in the IF group, and MAR was also higher in the IF group (P < 0.001 in models 1, 2, and 3). The IF group had significantly higher DDS and DVS than the non-IF group (P < 0.001). CONCLUSIONS The lunches provided in SLS facilities were better in terms of quantity and quality when provided through IF than through non-IF. More systematic foodservice programs should be implemented in SLS facilities, especially in facilities wherein users prepare their own meals.

The μ-opioid receptor (MOR) is a class of opioid receptors characterized by a high affinity for β-endorphin and morphine. MOR is a G proteincoupled receptor (GPCR) that plays a role in reward and analgesic effects. While expression of MOR has been well established in neurons and microglia, astrocytic MOR expression has been less clear. Recently, we have reported that MOR is expressed in hippocampal astrocytes, and its activation has a critical role in the establishment of conditioned place preference. Despite this critical role, the expression and function of astrocytic MOR from other brain regions are still unknown. Here, we report that MOR is significantly expressed in astrocytes and GABAergic neurons from various brain regions including the hippocampus, nucleus accumbens, periaqueductal gray, amygdala, and arcuate nucleus. Using the MORmCherry reporter mice and Imaris analysis, we demonstrate that astrocytic MOR expression exceeded 60% in all tested regions. Also, we observed similar MOR expression of GABAergic neurons as shown in the previous distribution studies and it is noteworthy that MOR expression is particularly in parvalbumin (PV)-positive neurons. Furthermore, consistent with the normal MOR function observed in the MOR-mCherry mouse, our study also demonstrates intact MOR functionality in astrocytes through iGluSnFr-mediated glutamate imaging. Finally, we show the sex-difference in the expression pattern of MOR in PV-positive neurons, but not in the GABAergic neurons and astrocytes. Taken together, our findings highlight a substantial astrocytic MOR presence across various brain regions.

Acute fatty liver of pregnancy (AFLP) is unusual but can potentially progress to overwhelming liver failure, resulting in maternal and fetal death. AFLP is characterized by the accumulation of microvesicular fat within hepatocytes. We report the case of a 37-year-old woman at 36 weeks' gestation with a twin pregnancy who was admitted with the diagnosis of intrauterine fetal death of one baby. The patient showed profile of AFLP on her laboratory findings and underwent emergency cesarean section. Then she progressed to cryptogenic fulminant hepatic failure and underwent successful orthotopic liver transplantation on 9th day of admission. This case demonstrates that liver transplantation is a feasible therapeutic option for the treatment of patients with this condition.
Adult ; Anesthesia, General ; Cesarean Section ; Diagnosis ; Emergencies ; Fatty Liver ; Female ; Fetal Death ; Hepatocytes ; Humans ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Liver ; Pregnancy ; Pregnancy, Twin

PURPOSE: Rufinamide (RFM) is known to be effective for children with Lennox-Gastaut syndrome (LGS). The aim of this study is to evaluate its efficacy and tolerability of Korean children with LGS. METHODS: This is a single center, open label, retrospective study. Patients with LGS who received rufinamide as adjunctive therapy were enrolled in this study. Their baseline clinical characteristics, the percent change in the seizure frequency per 4 weeks, and adverse events were evaluated. RESULTS: Among 32 children, 20 were males and the mean age was 11.3±6.6 years. After 1 month of rufinamide medication, the frequency of seizures was reduced by more than 50% in 31.3% of patients and 6.3% of patients had no seizures. After 6 months of rufinamide administration, patients with a 50% or less decrease in seizure frequency remained in a state of reduced seizure frequency and 3.1% of patients had no seizures. Side effects such as nausea, vomiting, anorexia, less active, somnolence, aggression, drooling were noted in 28.1% of patients. CONCLUSION: This study suggests that rufinamide can be considered as an effective and safe treatment option for intractable epileptic children such as LGS.
Aggression ; Anorexia ; Child* ; Epilepsy ; Humans ; Male ; Nausea ; Retrospective Studies ; Seizures ; Sialorrhea ; Vomiting

Brugada syndrome is an arrhythmic syndrome characterized by right bundle branch block, ST segment elevation in the precordial lead (V1-V3), and sudden death caused by ventricular fibrillation, which is not effectively prevented by anti-arrhythmic drug therapy. We are reporting a 30-year-old male patient with Brugada syndrome who got an exploratory laparotomy and a tenorrhaphy due to stab wound which was managed with general anesthesia and brachial plexus block without any complications.
Adult ; Anesthesia, General ; Brachial Plexus Block* ; Brachial Plexus* ; Brugada Syndrome* ; Bundle-Branch Block ; Death, Sudden ; Drug Therapy ; Humans ; Laparotomy ; Male ; Ventricular Fibrillation ; Wounds, Stab

Various types of stress affect mental health in the form of mood disorders, anxiety disorders, and suicidal ideation. Recently, the increasing suicide rate in the working-age population has become a major mental health concern in Korea. Thus, we investigated what kind of stress influence depression, anxiety, and suicidal ideation in Korean employees. The study participants were 189,965 employees who attended health screenings and responded to the Center for Epidemiologic Study-Depression Scale, the Beck Anxiety Inventory, and a questionnaire on the major causes of stress and suicidal ideation. We investigated the major causes of stress by gender and age categories and used binary logistic regression to determine the impact of the causes of stress on depression, anxiety and suicidal ideation. Of several stress causes, work-related stress was the most prevalent, regardless of age category and gender, followed by interpersonal relationships. However, interpersonal relationships and financial problems were the predominant causes of stress related to depression or suicidal ideation. This research suggests that despite the fact that work is the most common cause of stress for Korean employees, stress related to life problems other than work has a greater influence on the mental health of Korean employees.
Anxiety Disorders ; Anxiety* ; Depression* ; Korea ; Logistic Models ; Mass Screening ; Mental Health ; Mood Disorders ; Suicidal Ideation* ; Suicide

BACKGROUND: It is important to know and decide when to end regimen for the quality of life of the patients. However, there is currently no clear agreement on when to terminate palliative chemotherapy. We investigated the duration between the last chemotherapy and death, and associated factors affecting patients receiving palliative care after the last chemotherapy. METHODS: We studied 242 patients who were put into palliative care ward after receiving chemotherapy and died during hospitalization from 2008 to 2009. Electronic medical records were used to gather information on demographic characteristics, types of primary cancer, and palliative chemotherapy. Then we analyzed the relationship between the clinical characteristics of patients and interval between last chemotherapy and death. RESULTS: The average survival time of patients after referral to palliative care was 17.5 days; survival time after discontinuation of chemotherapy was 103 days. Also, 104 (43.0%) patients died within 3 months and 14 (5.8%) patients died within 1 month of persistent palliative chemotherapy. Chemotherapy on patients within 3 months from their death was not associated with the social characteristics of the population. CONCLUSION: The patients who were referred to palliative care were found to have continued to receive chemotherapy within 3 months before death. However, only a small number of patients received chemotherapy within 1 month before death, which confirms that futile chemotherapy that extends to the end of life was less frequent. Doctors should be able to recognize the implications of excessive and aggressive use of chemotherapy and should actively communicate with patients about therapeutic choices.
Electronic Health Records ; Hospitalization ; Humans ; Palliative Care ; Quality of Life ; Referral and Consultation ; Sociology