A 71-year-old male initially presented with vocal cord palsy and underwent tracheostomy. After thorough examination, urogenital dysfunction, orthostatic hypotension, and Parkinsonism were found, which led to the diagnosis of multiple system atrophy (MSA). After the tracheostomy, bi-level positive airway pressure ventilation was required during the night due to nocturnal hypoxemia. Night-time hypoxemia is related to central sleep apnea, which is one of the manifestations of MSA. This is the first case of MSA manifested by bilateral vocal cord palsy as an initial sign in Korea. This case supports the notion that MSA should be taken into consideration when vocal cord paralysis is observed.
Aged ; Airway Obstruction ; Anoxia ; Diagnosis ; Humans ; Hypotension, Orthostatic ; Korea ; Male ; Multiple System Atrophy* ; Parkinsonian Disorders ; Sleep Apnea, Central ; Tracheostomy ; Ventilation ; Vocal Cord Paralysis*

PURPOSE: Emergency physicians usually perform ultrasound exams for patients with multiple injuries. Extended focused assessment with sonography for trauma (eFAST) can reveal injuries from chest to the abdomen immediately. However, in Korea, the curriculums of medical schools do not currently include eFAST. We have devised a study to assess the feasibility of the eFAST exam in medical school students. METHODS: This study was conducted in students in their fifth year out of six years of medical school, over 11 weeks. Four Emergency Medicine specialists trained the students over 4 hours, tested the students, and conducted a questionnaire. RESULTS: Average age of students was 25.9+/-2.6 years, and 24 were male and 20 were female. Mean success rate of 17 components on the eFAST exam was 95.9% (94.6%-97.4%). The success rate of transverse view of aorta, transverse view of bladder, lung sliding sign, and sea-shore sign of both anterior chest walls was 100%, scanning the spleen and attaching the probe to a body surface were 75%, 86.3%. Total time consumption was 449.0+/-22.2 seconds. The questionnaires showed that the eFAST exam for the splenorenal recess, spleen, and left upper quadrant lung was difficult. CONCLUSION: We found that medical students in Korea could perform the eFAST exam by themselves after 4 hours education. In the future, these findings can be helpful in development of an eFAST education program for medical students.
Abdomen ; Aorta ; Curriculum ; Education ; Emergencies ; Emergency Medicine ; Female ; Humans ; Korea ; Lung ; Male ; Multiple Trauma ; Surveys and Questionnaires ; Schools, Medical* ; Specialization ; Spleen ; Students, Medical ; Thorax ; Ultrasonography ; Urinary Bladder

Four Cladobotryum isolates were collected from four different commercially grown mushroom types infected with cobweb disease in Cheongdo-gun and Chilgok-gun of Gyeongbuk Province, Korea in 2010. The isolates were identified as C. mycophilum from Agaricus bisporus and Pleurotus eryngii, C. varium from Flammulina velutipes and Hypsizygus marmoreus. The cultural characteristics of the four isolates were investigated using potato dextrose agar (PDA) media under nine different temperatures ranging from 5~32degrees C. Rapid growth of the isolates to colony diameters of 47~82 mm was observed at conditions of 18~22degrees C. No growth was observed at 32degrees C. C. mycophilum produced a yellowish red pigment while C. varium produced a cream colored pigment after cultivation for 25 days on PDA. Phylogenetic analysis of the internal transcribed spacer region and partial 28S rDNA from the four isolates confirmed they were C. mycophilum and C. varium. Cross pathogenicity tests revealed that the two isolates of C. mycophilum were highly pathogenic toward three mushroom types, but not toward H. marmoreus. The two isolates of C. varium were less pathogenic than those of C. mycophilum, but were pathogenic toward all mushroom types evaluated.
Agar ; Agaricales ; Agaricus ; Cultural Characteristics ; DNA, Ribosomal ; Flammulina ; Glucose ; Korea ; Pleurotus ; Solanum tuberosum

Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin’s lymphoma that selectively involves the lumina of vessels, and may present as ischemic stroke. A 62-year-old man presented with progressive aphasia, dementia, seizure and stroke-like symptom. Brain magnetic resonance imaging revealed dynamic progressive fluid attenuated inversion recovery lesions and multiple punctate microbleeds in the bilateral subcortical region. A kidney biopsy revealed IVLBCL. We report a patient with IVLBCL presenting as rapidly progressive encephalopathy.

objectives: ：This study aims to compare the mental health of adolescents living in child care institutions (orphanages) and youth shelters, to provide basic data for appropriate psychiatric interventions for each facilities. Methods: ：The sample consisted of 157 adolescents in child care institutions and 31 adolescents in Youth Shelters who completed the Korean version of the Youth Self Report (K-YSR). We compared the K-YSR scores between the two groups and also examined factors related to suicidality. Results: ：Adolescents in youth shelters were older and had higher rates of drinking (p<0.001), smoking (p<0.001), and “abnormal sleep” (p=0.007) than adolescents in child care institutions. They also showed higher ‘suicidality’ (p=0.004) and K-YSR scores. On the other hand, adolescents in child care institutions have lower ‘suicidality’, but they have higher ‘suicidality’ when they have ‘abnormal sleep’ (OR 4.194; p=0.006),abnormal diet’ (OR 2.503; p=0.010), and ‘concerns about weight gain’ (OR 2.503; p=0.010). Additionally, 17.6% of participants in the study showed ‘suicidality’. The ‘suicidality’ group had a higher overall K-YSR score than the non-suicidal group, and had higher ‘abnormal sleep’ (OR 3.766; p=0.014) and ‘concern about weight gain’ (OR 2.864; p=0.032). Conclusions ：Adolescents in youth shelters appear to have more serious clinical difficulties than adolescents in child care institutions, so prompt psychiatric intervention is needed. Additionally, it is necessary to consider mental health assessments including suicidality when adolescents in child care institutions complain of sleep, eating, or weight gain problems.

Objectives: : The purpose of this study is to identify the effect of office workers' stress level and stress vulnerability on heart rate variability (HRV), confirm the significance of objective stress indicators obtained through subjective stress and heart rate variability devices, and examine their effectiveness as an integrated stress measurement tool in community mental health projects. Methods: : From June to July in 2020, 929 workers participated in the stress management and mental health promotion project carried out by K hospital, and their recorded database was used for study analysis with their agreements. Multiple linear regression analysis was performed to find out the effects of general stress level, and stress vulnerability on heart rate variability. Results: : All general characteristics were found to have a significant effect on SDNN (ln), RMSSD (ln), LF (ln), and HF (ln), but work experience did not significantly affect RMSSD (ln). Stress level and stress vulnerability did not significantly affect heart rate variability, but stress perception, a sub-factor of stress level, was found to have a significant effect on RMSSD (ln) (β=0.118, p=0.023). Conclusions : In this study, stress perception, a sub-factor of stress level, was found to be a factor affecting RMSSD (ln). This indicates an association with the activity of parasympathetic nerves in stressful situations, and more follow-up studies are needed to use it as a direct indicator of chronic stress and integrated stress in the community mental health field.

Purpose: The aim of this study was to evaluate the validity and reliability of the Korean version of Short-form Health Literacy Scale (HLS-SF-K12) for Adults. Methods: The English HLS-SF12 was translated into Korean with forward and backward translation. Survey data were collected from 204 adults who visited two hospitals in Korea. Content validity, construct validity, and known-groups validity were evaluated. Cronbach's ⍺ for internal consistency and test-retest were used to assess reliability. SPSS 21.0 and AMOS 21.0 software were used for data analysis. Results: The HLS-SF-K12 was composed of 12 items, and three subscales (health care, disease prevention, and health promotion). The instrument explained reliable internal consistency with Cronbach’s ⍺ for the total scale of .89, and .74~.81 for subscales. The model of three subscales for the HLS-SF-K12 was validated by confirmatory factor analysis (Normed x 2 =2.14 (p<.001), GFI=.92, RMR=.04, RMSEA=.08, CFI=.94, TLI=.92, IFI=.94). The hypothesis testing which analyzed the differences in health literacy by age and education level was satisfied. Conclusion The HLS-SF-K12 is a valid and reliable instrument for measuring health information comprehension for adults in Korea.

Background: To date, the clinical significance of visually equivocal amyloid positron emission tomography (PET) has not been well established. Objective: We studied the clinical significance of equivocal amyloid PET images from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Methods: Subjects with F-18 florbetapir PET scans at baseline who were followed up for 4 years were selected. Clinical characteristics, imaging biomarkers, cognitive function, and rate of conversion to AD were compared in subjects with visually equivocal findings. Results Of 249 subjects who completed the follow-up, 153 (61.4%), 20 (8.0%), and 129 (30.5%) were F-18 florbetapir-negative, -equivocal, and -positive, respectively. The mean standardized uptake value ratios (SUVR) of F-18 florbetapir PET were 0.75 ± 0.04, 0.85 ± 0.10, and 1.00 ± 0.09 for each group (p <0.001 between groups), and 15.0%, 70.0%, and 98.7% of patients were quantitatively above the positive threshold. The change in the SUVR of F-18 florbetapir PET was higher in the equivocal (6.09 ± 3.61%, p <0.001) and positive (3.13 ± 4.38%, p <0.001) groups than the negative group (0.88 ± 4.28%). Among the subjects with normal or subjective memory impairment and mild cognitive impairment, 5.3% with negative amyloid PET and 37.5% with positive amyloid PET converted to AD over the 4-year period. None of the equivocal amyloid PET subjects converted to AD during this period.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.