OBJECTIVES: The aim of this study is to evaluate the polysomnographic characteristics and prescription status of restless legs syndrome (RLS) patients in naturalistic setting. METHODS: We reviewed medical record of the patients over 18 years olds who (i) satisfied the clinical RLS diagnostic criteria and (ii) had the polysomnography and got treatment related thereto. As a baseline, we evaluated the four diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG) and the International Restless Legs Scale (IRLS) of the subjects. Then the polysomnography and the suggested immobilization test (SIT) were conducted and, after one month of pharmacotherapy using dopamine agonist, the IRLS was evaluated again. RESULTS: A total of 211 subjects participated in this analysis and 94 (44.5%) of them were male and the other 117 (55.5%) were female and the average age of the 211 subjects was 46.9+/-14.2. Out of such 211 subjects, 136 subjects (64.5%) also had the obstructive sleep apnea (OSA), and 53 subjects (25.1%) also had the periodic limb movement disorder (PLMD). 185 subjects (87.7%) out of the 211 subjects had some other sleep disorders except RLS. The results of the polysomnography were as follows : 78.0% of sleep efficiency, 86.8 min of wake after sleep onset, and 3.4% of N3. More specifically, 12.4/h of the average apnea hypopnea index, 14.8/h of the periodic limb movement during sleep (PLMS), 41.2/h of the periodic limb movement during wake during SIT and 21.6/h of total arousal index during sleep. Out of the total subjects, 149 (70.6%) of them took the ropinirole and 47 (22.3%) of them took the pramipexole, and the average dosage of ropinirole was 0.9mg(dosage range 0.125-5 mg) while the average dosage of pramipexole was 0.5 mg (dosage range 0.125-4 mg). The dosage of the ropinirole showed a significant positive correlation with the age (r=0.25, p=0.002) and also with the IRLS (r=0.23, p=0.038). The IRLS at the baseline was 24.9 while the same was decreased down to 13.4 after one month. CONCLUSIONS: Analyzing the result of this study, a majority of clinical RLS subjects demonstrated comorbidity with some other sleep disorder such as the OSA or PLMD. 25.1% of the subjects showed a PLMD, which was less than in previous researches and the average PLMS was not very high as 14.8/h. The dosage of dopamine agonist taken was often a bit more than the amount recommended in Korea. A prospective research using a large scale controlled subjects will be necessary with respect to this topic.
Apnea ; Arousal ; Benzothiazoles ; Comorbidity ; Dopamine Agonists ; Extremities ; Female ; Humans ; Immobilization ; Indoles ; Isothiocyanates ; Korea ; Male ; Medical Records ; Nocturnal Myoclonus Syndrome ; Polysomnography ; Prescriptions ; Restless Legs Syndrome ; Sleep Apnea, Obstructive ; Sleep Wake Disorders

OBJECTIVES: This study examined the reliability and validity of the Korean version of Asperger Syndrome Diagnostic Scale (K-ASDS), to calculate the cut-off score in the diagnosis of Asperger syndrome. Further, we examined classification error rate when applying cut-off scores. METHODS: One hundred sixty-seven children participated in this study, including 46 with Asperger syndrome, 26 with PDD or PDD NOS, 43 with ADHD, and 52 normal children. RESULTS: An ANCOVA demonstrated no significant differences in the K-ASDS total score between the Asperger and the PDD & PDD NOS groups. However, these groups did show significantly higher scores than the ADHD and normal groups. Among the five subscales on the K-ASDS, the Asperger group obtained significantly higher scores on the language and cognition subscales than the PDD & PDD NOS groups. Two scales were found to be useful in distinguishing the Asperger group from the PDD & PDD NOS group through a discriminant analysis. According to an analysis of ROC curve, the cut-off score on the K-ASDS for the diagnosis of PDD including Asperger syndrome was 121. CONCLUSION: We discussed that K-ASDS has pretty limit.
Asperger Syndrome ; Child ; Cognition ; Humans ; Reproducibility of Results ; ROC Curve ; Weights and Measures

PURPOSE: The aim of this study was to evaluate the effectiveness of interventions for workplace bullying among nurses. METHODS: First, risk factors of workplace bullying were categorized in order to create analysis criteria. A search of 8 databases, and manual searching resulted in the identification of 3,096 relevant articles. Three of the authors did article selection, data extraction, and quality assessment using the Risk of Bias (RoB) and the Risk of Bias for Nonrandomized studies (ROBANS). RESULTS: Interventions in workplace bullying were classified as individual, interactions, and organizational approach. Twelve intervention studies (10 individual interventions, 1 team approach, 1 multi-level approach) were selected. Four of the individual interventions decreased bullying, but three had no effect. One multi-level intervention reported that bullying did not occur. Individual interventions improved bullying awareness in four articles, decreased turnover intention in two articles, and increased skill and knowledge of bullying management in five articles. One team approach increased nurse interactions and group cohesion. The quality of selected articles was low overall. CONCLUSION: Individual interventions have a possibility to improve awareness and knowledge about bullying, but there is a lack of evidence on preventing bullying. Further research is required on multi-levels interventions with well-designed controlled trials.
Bias (Epidemiology) ; Bullying ; Intention ; Risk Factors

PURPOSE: The majority of upper and lower ureteral stones are primarily treated by extracorporeal shock wave lithotripsy(ESWL), but the optimal treatment for ureteral stones overlying the pelvic bone(middle third of the ureter) remains unclear and controversial. MATERIALS AND METHODS: From April 1999 to March 2003, out of 70 patients with stones in the middle third of the ureter, 62 who were followed up continuously were included in this study. Shock waves to the stones were delivered from the back because their pelvic bones were barriers for shock waves. We used third generation ESWL, Modulith SLX(R)(Storz, Germany). Patients who were treated primarily with ureterolithotomy or ureteroscopic stone removal were excluded from the study. The success and complication rates were analyzed. RESULTS: The overall stone free rates were 88.7% with ESWL. Out of 62 stones, 33 were removed at the middle third of the ureter, 25 migrated to the distal ureter, and 4 that remained at the same site were removed by ureterolithotomy. Out of the 25 stones which migrated to the distal ureter, 22 were removed by repeated ESWL, but 3 required ureteroscopy for removal. Complications were shown in 6 patients: gross hematuria persisting more than 48 hours in 3, abdominal and flank pain in 1, UTI with fever in 1, and steinstrasse in 1. CONCLUSIONS: In our study, ESWL provided satisfactory success rates even in the mid-ureteral stones. It is a noninvasive, simple and safe option for the management of stones in the middle third of the ureter.
Fever ; Flank Pain ; Hematuria ; Humans ; Lithotripsy ; Pelvic Bones ; Shock* ; Ureter ; Ureteroscopy ; Urolithiasis

BACKGROUND AND OBJECTIVES: Cone beam CT is a relatively new radiologic technique for head and neck imaging, and is widely used in dentistry to plan implant procedures. Compared to conventional CT, it has greater spatial resolution, a lower radiation dose (about 10% that of conventional CT), and lower cost. The objective of this study was to evaluate the utility of cone beam CT for endoscopic sinus surgery. SUBJECTS AND METHODS: A total of 50 patients were involved. Endoscopic sinus surgery was performed unilaterally under local anesthesia, so we used the half Lund-Mackay score to quantify preoperative CT findings. The intraoperative severity score was also determined, and the relationship between the preoperative Lund-Mackay score and intraoperative severity was assessed. The subjective level of operator satisfaction was scored on a ten-point visual analogue scale in terms of four items: overall satisfaction, disease extent of each sinus, identification of anatomic landmarks, and distinction of soft tissue characteristics. RESULTS: The preoperative half Lund-Mackay score was 5.26 and the intraoperative severity score was 5.02; these two scores were significantly correlated (p < 0.01). The level of overall operator satisfaction was relatively high (9.04/10). CONCLUSION: Cone beam CT is a useful imaging method for preoperative evaluation of endoscopic sinus surgery.
Anatomic Landmarks ; Anesthesia, Local ; Cone-Beam Computed Tomography ; Dentistry ; Head ; Humans ; Neck

We aimed to investigate epidemiology and host- and pathogen-related factors associated with clinical severity of acute gastroenteritis (AGE) in children after rotavirus vaccination introduction. Factors assessed included age, co-infection with more than 2 viruses, and virus-toxigenic Clostridium difficile co-detection. Fecal samples and clinical information, including modified Vesikari scores, were collected from hospitalized children with AGE. The presence of enteric viruses and bacteria, including toxigenic C. difficile, was detected by polymerase chain reaction (PCR). Among the 415 children included, virus was detected in stool of 282 (68.0%) children. Co-infection with more than 2 viruses and toxigenic C. difficile were found in 24 (8.5%) and 26 (9.2%) children with viral AGE, respectively. Norovirus (n = 130) infection, including norovirus-associated co-infection, was the most frequent infection, especially in children aged < 24 months (P < 0.001). In the severity-related analysis, age < 24 months was associated with greater diarrheal severity (P < 0.001) and modified Vesikari score (P = 0.001), after adjustment for other severity-related factors including rotavirus status. Although the age at infection with rotavirus was higher than that for other viruses (P = 0.001), rotavirus detection was the most significant risk factor for all severity parameters, including modified Vesikari score (P < 0.001). Viral co-infection and toxigenic C. difficile co-detection were not associated with any severity-related parameter. This information will be helpful in the management of childhood AGE in this era of rotavirus vaccination and availability of molecular diagnostic tests, which often lead to the simultaneous detection of multiple pathogens.
Bacteria ; Child ; Child, Hospitalized* ; Clostridium difficile ; Coinfection ; Epidemiology* ; Gastroenteritis* ; Humans ; Norovirus ; Pathology, Molecular ; Polymerase Chain Reaction ; Risk Factors ; Rotavirus* ; Vaccination*

Anti-programmed cell death-1 (PD-1) humanized monoclonal antibody inhibits PD-1 activity by binding to the PD-1 receptor on T-cells and blocking PD-1 ligands and induces immune tolerance of cancer cells. It has been widely used for various kinds of cancer treatment. However, many immune-related adverse events (irAEs) have been reported because it modulates our immune system. In this case study, we reported a case of 42-year-old woman with Hashimoto's thyroiditis who showed rapid aggravation of thyroid goiter and acute hyperventilation syndrome after treatment with PD-1 inhibitor as a neoadjuvant chemotherapy for breast cancer.
Adult ; Breast Neoplasms ; Breast ; Drug Therapy ; Female ; Goiter ; Humans ; Hyperventilation ; Immune System ; Immune Tolerance ; Ligands ; Programmed Cell Death 1 Receptor ; T-Lymphocytes ; Thyroid Gland ; Thyroiditis