OBJECTIVES: This study investigated the effects of chronic medical diseases on depressive symptoms in individuals at high risk for depression living in rural areas, over a 1-year period.METHODS: A community-based longitudinal study was conducted; 67 participants aged 18–79 years residing in rural areas were included. In the first survey, all participants completed a self-report questionnaire battery. An interview was also conducted to obtain data on demographic variables and current or past chronic medical diseases. In the first survey, participants with the Center for Epidemiologic Studies Depression scale(CES-D) scores of 16 or higher were categorized as being at high risk for depression; the same assessments were carried out 1 year later in a follow-up survey. Multiple regression analysis was performed to determine the association of chronic medical diseases with 1-year follow-up depressive symptoms in the high-risk group.RESULTS: In model 1, which controlled for sociodemographic variables, the number of chronic medical diseases (p =0.026), baseline severity of depressive symptoms(p =0.002), and presence of diabetes(p =0.039) were significantly associated with the follow-up CES-D scores. In model 2, which further adjusted for Alcohol Use Disorder Identification Test and Beck Anxiety Inventory scores, the number of chronic medical diseases(p =0.036), baseline severity of depressive symptoms(p =0.017), and prevalence of diabetes(p =0.037) were also significantly associated with the follow-up CES-D scores.CONCLUSION: This study suggests that the number of chronic medical diseases, prevalence of diabetes, and severity of depressive symptoms are significantly associated with 1-year follow-up depressive symptoms in individuals at high risk for depression.
Anxiety ; Depression ; Diabetes Mellitus ; Epidemiologic Studies ; Follow-Up Studies ; Longitudinal Studies ; Prevalence ; Rural Population

BACKGROUND: The demand for Rh-related and other specific antigen negative donations has increased recently, and in response, we need to improve work efficiency while decreasing reagent consumption. Thus, we desire to create a ‘table of Nambu Blood Laboratory Center's own Rh-related and other antigen negative rate’. METHODS: We analyzed the results of Rh-related specific antigen test for 2,806,330 donors using ‘PK-7300’ and the results of manual test for 10,024 other blood type antigen-related specific and compound antigens. We made a table summarizing the results using two cases. RESULTS: The negative rate of Rh-related specific antigens was approximately 12.9% for C, 41.7% for c, 49.5% for E, and 9.2% for e antigens. The negative rate of compound antigens was increased when compared with the number of inspections. The negative rate for C and e antigens was increased from 90.1% to 97.3%, and that for E, c, and JKa was increased from 7.6% to 31.6%. CONCLUSION: The negative rate table made in July 2016 has been determined to be very effective in screening for specific and compound antigen negative blood. Also it was very efficient in terms of examining and supplying the compound antigen negative blood. It would be helpful to improve the supply of specific antigen negative blood to better meet the unique needs of each medical institution.
Hepatitis B e Antigens ; Humans ; Mass Screening ; Tissue Donors

PURPOSE: This study was conducted to explore the process and operation of a cancer multidisciplinary team (MDT) after the reimbursement decision in Korea, and to identify ways to overcome the major barriers to effective and sustainable MDTs. MATERIALS AND METHODS: Approximately 1,000 cancer specialists, including medical oncologists, surgical oncologists, radiation oncologists, pathologists, and radiologists in general hospitals in Koreawere invited to complete the survey. The questionnaire covered the following topics: organizational structure of MDTs, candidates for consulting, the clinical decision-making initiative, and responsibility for dealing with legal disputes. RESULTS: We collected a total of 179 responses (18%) from physicians at institutions where an MDT approach was active. A surgical oncologist (91%), internist (90%),radiologist (89%),radiation oncologist (86%), pathologist (71%), and trainees (20%) regularly participated in MDT operations. Approximately 55% of respondents stated that MDTs met regularly. In cases of a split opinion, the physician in charge (69%) or chairperson (17%) made the final decision, and most (86%) stated they followed the final decision. About 15% and 32% of respondents were “very satisfied” and “satisfied,” respectively, with the current MDT's operations. Among 38 institutional representatives, 34% responded that the MDT operation became more active and 18% stated an MDT was newly implemented after the reimbursement decision. CONCLUSION: The reimbursement decision invigorated MDT operations in almost half of eligible hospitals. Dissatisfaction regarding current MDTs was over 50%, and the high discordance rates regarding risk sharing suggest that it is necessary to revise the current system of MDTs.
Clinical Decision-Making ; Dissent and Disputes ; Hospitals, General ; Korea* ; Specialization ; Surveys and Questionnaires

ANCA-associated vasculitis is one of the immunologic cause of diffuse alveolar hemorrhage (DAH). We experienced a rare case of recurrent DAH in a 67-year-old man with ANCA-associated vasculitis who had been on maintenance hemodialysis. Two years ago, he presented with renal failure and hemoptysis. Hemoptysis caused by DAH was resolved immediately and hemodialysis was applied because of persistent uremic symptom. On maintenance hemodialysis, three recurrences have happened so far. At present, oral prednisolone and oral cyclophosphamide are being maintained during outpatient follow-up. Our report suggests that the nephrologist must be concerned about the possibility of recurrent aleveolar hemorrhage in ANCA associated renal disease patients and consider immunosuppressive treatment, even though the patient has been on maintenance hemodialysis.
Aged ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis ; Antibodies, Antineutrophil Cytoplasmic ; Cyclophosphamide ; Follow-Up Studies ; Hemoptysis ; Hemorrhage* ; Humans ; Outpatients ; Prednisolone ; Recurrence ; Renal Dialysis ; Renal Insufficiency ; Vasculitis*

BACKGROUND: Acute renal infarction is an uncommon disease which is often delyed or missed due to its rarity and unspecific clinical presentation. METHODS: In order to evaluate the clinical features and to elucidate diagnostic or therapeutic options, we analyzed the medical records of 23 patients who were admitted to Pusan National University Hospital from January, 1995 to July, 2004 and diagnosed as renal infarction. RESULTS: The mean age of the patients was 57.3 18.4 years and male to female ratio was 0.91:1. Underlying diseases were cardiovascular disease (n=18), tumor embolism (n=1), vasculitis (n=1), post kidney transplantation thrombosis (n=1), and trauma(n=1). One patient did not have any underlying disease. Initial symptoms were abdominal or flank pain (61%), fever (35%), anorexia (35%), nausea (26%), vomiting (17%), gross hematuria (9%), and oliguria (4%). On physical examination, costovertebral angle tenderness (43%), abdominal tenderness (9%), and hypertension (35%) were noted. Initial abnormal laboratory findings were elevated serum level of LDH (100%), AST (87%), ALT (83%), CK (22%), and creatinine (>1.4 mg/dL, 17%). Imaging diagnosis of renal infarction included renal angiography, isotope renal scan, computed tomography or ultrasonography. CT was done in 17/23 cases and useful in diagnosis of renal infarction. Nine patients were treated with heparin or warfarin. Thrombolysis was done in 3 patients. Others were treated conservatively. CONCLUSIONS: In a patients with an increased risk of thromboembolism, flank or abdominal pain, microscopic hematuria, and an elevated serum LDH are strongly supportive of diagnosis of renal infarction. Under such circumstances, enhanced CT is essential for the early diagnosis of renal infarction.
Abdominal Pain ; Angiography ; Anorexia ; Busan ; Cardiovascular Diseases ; Creatinine ; Diagnosis ; Early Diagnosis ; Female ; Fever ; Flank Pain ; Hematuria ; Heparin ; Humans ; Hypertension ; Infarction* ; Kidney Transplantation ; Male ; Medical Records ; Nausea ; Neoplastic Cells, Circulating ; Oliguria ; Physical Examination ; Renal Insufficiency ; Thromboembolism ; Thrombosis ; Ultrasonography ; Vasculitis ; Vomiting ; Warfarin

Mycophenolate mofetil (MMF) is a immunosuppressive agent increasingly used in organ transplantation and autoimmune disease. We report a case about use of MMF in SLE patient with rapidly worsening renal function. A 24-year old female was admitted due to 1-week history of generalized edema. Despite use of diuretics and conventional supported care, generalized edema was more aggravated and serum creatinine was elevated up to 5.2 mg/dL. Ten days after the initial admission, we started hemodialysis. After hemodialysis, improvement of generalized edema was achieved. Eighteen days after initial hemodialysis, we started corticosteroids and MMF because she shows persistent heavy proteinuria and oliguria. After use of corticosteroids and MMF, clinical improvement of renal complication was achieved in this patient. About 6 weeks later, we could discontinue hemodialysis. On two year follow up duration, she shows good renal function and no evidence of lupus flare-up signs. We suggest MMF is one of therapeutic options for patients with severe lupus nephritis, especially those refractory or intolerant to conventional cytotoxic agents.
Acute Kidney Injury* ; Adrenal Cortex Hormones ; Autoimmune Diseases ; Creatinine ; Cytotoxins ; Diuretics ; Edema ; Female ; Follow-Up Studies ; Humans ; Lupus Nephritis* ; Oliguria ; Organ Transplantation ; Proteinuria ; Renal Dialysis ; Transplants ; Young Adult

BACKGROUND: Poor HLA matched donors may become an additional organ source for renal transplantation. This study is conducted to predict the clinical outcomes of renal transplantation in a poor HLA matched group (0 or 1 or 2 HLA matching) by comparing them with those of HLA haploidentical group. METHODS: This study compared a poor HLA matched group (N=89) with HLA haploidentical group (N=79) to analyze differences between two groups in graft survival, incidence of acute rejection, cause of graft failure, posttransplant serum creatinine at 1, 2, 3, 5 years. Total 168 cases, appeared in the medical records for more than six months in Bong-Saeng Hospital, from December, 1984 to March, 2004 were traced and identified as relevant cases for this study. RESULTS: Allograft survival rate at 1, 3, 5, 10 years for poor HLA matched group and HLA haploidentical group were 100%, 98.6%, 95.4%, 72.5% and 100%, 100%, 96.1%, 86.2% (p=not significant) respectively. Acute rejection developed in 25.8% of poor HLA matched group versus 18.9% of HLA haploidentical group (p=not significant). The most common causes of graft failure in both groups were chronic rejection. CONCLUSIONS: It should be actively encouraged to consider renal transplantation in a poor HLA matched group as the results of this study support that the clinical outcomes of renal transplantation in a poor HLA matched group are equivalent to those of HLA haploidentical group.
Allografts ; Creatinine ; Graft Survival ; Humans ; Incidence ; Kidney Transplantation* ; Kidney* ; Medical Records ; Research Design ; Survival Rate ; Tissue Donors* ; Transplants

BACKGROUND: Chronic kidney disease has deleterious influences on pregnancy, both fetus and mother. To determine the pregnancy outcome and associated risk factors, we analyzed 36 pregnancies in 26 women with various chronic kidney diseases. METHODS: Retrospective analysis of 36 pregnancies was performed in women with chronic kidney disease who underwent antenatal care and delivery at Pusan National University Hospital from January 1993 to December 2002. RESULTS: The mean age of patients was 29.7 +/- 3.6 years. Underlying kidney disease was lupus nephritis in 10 patients (11 pregnancies), IgA nephropathy in 7 patients (8 pregnancies), focal segmental glomerulosclerosis in 4 patients (9 pregnancies), membranoproliferative glomerulonephritis in 4 patients (7 pregnancies), membranous glomerulonephritis in 1 patient (1 pregnancy). Of the 36 pregnancies, fetal loss occurred in 14 pregnancies (38.9%), premature delivery 7 pregnancies (19.4%) and normal delivery 15 pregnancies (41.7%). Deterioration of maternal renal function occurred in 10 pregnancies (27.8%), hypertension 18 pregnancies (50.0%) and aggravation of proteinuria 26 pregnancies (72.2%). Fetal loss and deterioration of maternal renal function were more frequent in patients with preconception serum creatinine value (SCr) >or=1.4 mg/dL than in those with SCr <1.4 mg/dL (85.7% vs. 27.6%, p<0.05; 100% vs. 10.3%, p<0.05, respectively). Neither fetal loss nor deterioration of maternal renal function was associated with hypertension and aggravation of proteinuria. In multivariate analysis, preconception SCr was associated with fetal loss (p=0.014, OR 32.7, 95% CI 2.0-526.0) and BP >or=140/90 mmHg during pregnancy was associated with low birth weight (p=0.027, OR 0.034, 95% CI 0.002-0.682). Deterioration of maternal renal function during pregnancy was recovered in 40.0%, hypertension was recovered in 50.0% and proteinuria was recovered in 77.8% within 1 year after delivery. CONCLUSION: Preconceptional impairment of maternal renal function and uncontrolled hypertension during pregnancy seem to be an important factors associated with fetal loss and low birth weight, respectively.
Busan ; Creatinine ; Female ; Fetus ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Humans ; Hypertension ; Infant, Low Birth Weight ; Infant, Newborn ; Kidney Diseases ; Lupus Nephritis ; Mothers ; Multivariate Analysis ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Proteinuria ; Renal Insufficiency, Chronic* ; Retrospective Studies ; Risk Factors

Grapefruit seed extract has been reported to have antimicrobial effect. The purpose of this study was to evaluate the antimicrobial and anti-gingivitis effect of chewing gum containing grapefruit seed extract and xylitol. 40 healthy subjects with gingivitis or early periodontitis were divided into two groups. Subjects in the experimental group chewed gum containing grapefruit seed extract and xylitol while subjects in the control group chewed gum containing only xylitol. All subjects received scaling and tooth brushing instruction. 1 week after scaling was set as baseline. Gingival index and plaque index were scored at baseline, 1 week, 2 week, 3 week and 4 week. Bleeding index, probing pocket depth and clinical attachment level were scored at baseline, 2 week and 4 week. The number of total bacteria and Streptococcus mutans in unstimulated saliva of experimental group were counted at 1 week, 2 week, 3 week and 4 week. Gingival indices of experimental group and control group at baseline, 1 week, 2 week, 3 week and 4 week were 0.850+/-0.298, 0.575+/-0.345, 0.533+/-0.332, 0.459+/-0.311, 0.408+/-0.224 and 0.758+/-0.379, 0.592+/-0.296, 0.563+/-0.281, 0.454+/-0.194, 0.413+/-0.199 (mean+/-SD), respectively. Plaque indices of experimental group and control group at baseline, 1 week, 2 week, 3 week and 4 week were 0.497+/-0.500, 0.375+/-0.484, 0.332+/-0.471, 0.286+/-0.452, 0.210+/-0.407 and 0.411+/-0.492, 0.375+/-0.484, 0.354+/-0.479, 0.313+/-0.463, 0.193+/-0.395, respectively. Bleeding indices of experimental group and control group at baseline, 2 week and 4 week were 0.377+/-0.177, 0.298+/-0.152, 0.192+/-0.108 and 0.383+/-0.124, 0.318+/-0.153, 0.225+/-0.126, respectively. Probing pocket depth of experimental group and control group at baseline, 2 week and 4 week were 2.56+/-1.00, 2.40+/-0.65, 2.23+/-0.64 and 2.45+/-0.68, 2.37+/-0.57, 2.19+/-0.57, respectively. Clinical attachment level of experimental group and control group at baseline, 2 week and 4 week were 2.58+/-1.01, 2.43+/-0.67, 2.26+/-0.65 and 2.49+/-0.70, 2.40+/-0.59, 2.22+/-0.62, respectively. The % of reduction of total bacteria in saliva of experimental group at 2 week, 3 week and 4 week were 46 +/- 53%, 53 +/- 5% and 69 +/- 33%. The % of reduction of Streptococcus mutans count in saliva of experimental group at 2 week, 3 week and 4 week were 52 +/- 69%, 88 +/- 30% and 89 +/- 17%. From these findings, it can be concluded that regular use of grapefruit seed extract /xylitol chewing gum may be effective to control and prevent gingivitis and may have caries-preventive effect.

BACKGROUND: Acute pyelonephritis (APN) is an unusual cause of acute renal failure (ARF) in patients without urinary obstruction and other predisposing conditions. Therefore, in the differential diagnosis of ARF, APN is rarely considered. METHODS: We retrospectively analyzed the data from the patients with ARF secondary to APN (ARF group, n=8) with normal renal anatomy and no known predisposing conditions which lead to ARF during the course of acute bacterial pyelonephritis, and investigated the differences of clinical parameters to the patients with uncomplicated APN (control group, n=20). RESULTS: Female were predominant in both groups. The mean age was 49.2+/-14.4 years in control group and 56.3+/-16.4 years in ARF group. On admission, the body temperature was 37.5+/-1.14degrees C in control group and 36.62+/-0.32degrees C in ARF group (p= 0.003). The days of pyuria, duration days of costovertebral angel (CVA) tenderness and hospitalization days were significantly prolonged in ARF group. CVA tenderness was unilateral in 65% of control group and bilateral in 65% of ARF group. Amounts of daily urine protein excretion were 0.15+/-0.48 gm/ day in control group and 2.99+/-2.89 gm/day in ARF group (p=0.001). Creatinine clearance and FeNa were 24.04+/-15.98 mL/min and 2.80+/-2.68 in patients group, respectively. Development of ARF had positive correlation with the duration of pyuria (r=0.579, p< 0.01), amounts of daily urine protein excretion (r=0.854, p< 0.01), duration of CVA tenderness (r=0.461, p< 0.05) and had a negative correlation with body temperature (r=-0.402, p< 0.05). CONCLUSION: APN is a rare but important cause of acute renal failure. Patients with ARF secondary to APN seems to have more prolonged period of pyuria and CVA tenderness, apyrexia and excrete more protein in urine than patients with uncomplicated APN. Adequate treatment of the bacterial infection by prompt antibiotic treatment may lead to full recovery of renal function.
Acute Kidney Injury* ; Bacterial Infections ; Body Temperature ; Creatinine ; Diagnosis, Differential ; Female ; Hospitalization ; Humans ; Pyelonephritis* ; Pyuria ; Retrospective Studies