OBJECTIVE: Nonstress test(NST) has become an important method of antepartum evaluation of fetal well-being. The fetal heart rate(FHR) testing is used frequently as a nonstress test(NST). However, NST highly depends on whom to interpret the result of FHR testing. Recently, for interpretation of FHR, objective decision methods using softwares have been introduced. In this study, we aim to analyse the correlation between each variable affecting FHR and fetal outcome using objective decision basis with principal component analysis and multiple regression analysis. MATERIALS AND METHODS: The clinical observation was made on 5,314 data from pregnant women who took a NST which had been collected from 1989 to 1997 at Hanyang University Hospital. For collection of data and values of each variable, we used our own FHR interpretation softwares, HYFM-I(DOS version, 1989) and HYFM-II(Window-version, 1998). Then, the principal component analysis is performed to find significant variable and multiple regression analysis using these variables. RESULTS: Each groups were divided and classified as followings ; 1 minute Apgar score-normal, 1 minute Apgar score-abnormal, 5 minute Apgar score-nomal, 5 minutes Apgar score-abnormal; there is significant difference between signal loss and 1 minute Apgar score only. And significant difference was shown between mean baseline FHR, FHR variability-amplitude, FHR variability-MMR, and fetal outcomes(body weight of newborn & Apgar score). The FHR variability-amplitude, FHR variability-MMR, and weight of baby were important values in predict of fetal well-being. CONCLUSIONS: In conclusion, there are close relation in each variable of FHRand fetal outcome. The result of this study would be useful background data in the development of objective and automated FHR analysis software, especially in the computerized FHR analysis system.
Apgar Score ; Female ; Fetal Heart* ; Heart Rate, Fetal* ; Humans ; Infant, Newborn* ; Pregnancy ; Pregnant Women ; Principal Component Analysis

BACKGROUND: Recently, an elevated serum homocysteine level has been reported to be associated with increased fracture risk and reduced bone mineral density (BMD). So far, little research has been done to evaluate such association in Korean population. Therefore, we investigated the association between serum homocysteine levels and BMD in Korean adults. METHODS: The subjects consisted of 2,750 adults who visited a health promotion center at a university hospital from January 2005 to March 2006. Self-administered questionnaires provided information about lifestyle and medical history. Fasting plasma samples were collected and BMD of the lumbar spine and femoral neck were obtained by dual energy X-ray absorptiometry. To adjust for menopausal state, the female subjects were divided into three groups according to age (< or =45 yrs, 46~55 yrs, 55 yrs <). Multiple linear regression analysis was used to evaluate the association between serum homocysteine levels and BMD in each gender and age group. RESULTS: The results adjusted for alcohol and smoking history showed significant association between serum homocysteine levels and BMD in women (Lumbar spine: beta=-0.006, P=0.015, Femoral neck: beta=-0.065, P=0.012) but not in men (Lumbar spine: beta=0.001, P=0.240, Femoral neck: beta=0.001, P=0.242). With analyses by three age groups, plasma homocysteine level was associated with both lumbar and femoral BMD in age 46~55 women (Lumbar spine: beta=-0.014, P=0.024, Femoral neck: beta= -0.007, P=0.019). CONCLUSION: Our study suggests that increased serum homocysteine level is an independent risk factor for low BMD among women, especially perimenopausal women. Further studies about the sexual differences and the mechanisms linking serum homocysteine level to BMD are needed.
Absorptiometry, Photon ; Adult ; Bone Density ; Fasting ; Female ; Femur Neck ; Health Promotion ; Homocysteine ; Humans ; Life Style ; Linear Models ; Male ; Osteoporosis ; Plasma ; Risk Factors ; Smoke ; Smoking ; Spine ; Surveys and Questionnaires

Behcet's disease is a systemic inflammatory disorder of unknown etiology, characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Renal involvement is rare in patients with Behcet's disease particularly immunoglobulin A (IgA) nephropathy. Other autoimmune diseases have been associated with increased risk of malignancy, but not Behcet's disease. Some cases of Behcet's disease accompanied by bladder cancer, thyroid cancer, stomach cancer, or hematologic malignancies have been reported. However, to the best of our knowledge, co-occurrence of Behcet's diseases with thymic carcinoma has not yet been reported. We experienced a 49-year-old male patient who had been treated for Behcet disease and IgA nephropathy, who presented with a large mediastinal mass on chest x-ray. After thymectomy, he was diagnosed with thymic carcinoma with complete resection.
Autoimmune Diseases ; Behcet Syndrome ; Glomerulonephritis, IGA* ; Hematologic Neoplasms ; Humans ; Immunoglobulin A ; Male ; Middle Aged ; Skin ; Stomach Neoplasms ; Stomatitis, Aphthous ; Thorax ; Thymectomy ; Thymoma* ; Thyroid Neoplasms ; Ulcer ; Urinary Bladder Neoplasms ; Uveitis

Norwegian scabies can be defined as a generalized, severe scabies infestation which usually affects immunocompromised patients. The diagnosis is commonly missed, and can lead to mismanagement. We describe a patient with Norwegian scabies affecting the whole body. The patient had suffered with pemphigus foliaceus for several years and had an immunosuppressed status due to long-term use of oral corticosteroids. He was admitted to our hospital. At first, we made a diagnosis of exfoliative dermatitis secondary to pemphigus foliaceus. However, no improvement of the condition was seen after an increased dosage of oral corticosteroids, azathioprine, and mycophenolate mofetil. We then identified adult scabietic mites, eggs and scybala upon microscopic examination of skin scales. He was treated with an application of gamma benzene hexachloride cream. We recommend that the diagnosis of scabies be considered in immunocompromised patients with thick skin scales and associated night pruritus.
Adrenal Cortex Hormones ; Adult ; Azathioprine ; Dermatitis, Exfoliative ; Diagnosis ; Eggs ; Humans ; Immunocompromised Host ; Lindane ; Mites ; Ovum ; Pemphigus* ; Pruritus ; Scabies* ; Skin ; Weights and Measures

Meckel-Gruber syndrome is a multiple malformation syndrome featuring occipital meningoencephalocele, multicystic dysplasia of kidney, cystic and fibrotic change of liver, polydactyly, and other characteristics inherited by the autosomal recessive trait. We exprienced a case of Meckel-Gruber syndrome in a newborn male diagnosed clinically and confirmed pathologically. Abnormalities of the fetus were found prenataly by ultrasonogram, and subsequently the baby was terminated by cesarean section delivery at 32 weeks of gestational age. We report this case with brief review of literature.
Cesarean Section ; Female ; Fetus ; Gestational Age ; Humans ; Infant, Newborn ; Kidney Diseases, Cystic ; Liver ; Male ; Polydactyly ; Pregnancy ; Ultrasonography

Acute esophageal necrosis is a rare clinical entity characterized by the endoscopic finding of extensive black discoloration of the esophageal mucosa. Acute esophageal necrosis in a patient with diabetic ketoacidosis has rarely been reported. We report a case of acute esophageal necrosis in a patient with diabetic ketoacidosis. The patient had coffee ground emesis and, after an esophagogastroduodenoscopy with mucosal biopsy, acute esophageal necrosis was diagnosed. The patient was treated conservatively with an intravenous proton pump inhibitor and oral sucralfate without any complications.
Biopsy ; Coffee ; Diabetes Mellitus ; Diabetic Ketoacidosis ; Endoscopy, Digestive System ; Esophagus ; Humans ; Mucous Membrane ; Necrosis ; Proton Pumps ; Sucralfate ; Vomiting

BACKGROUND: The family medicine residency program consists mainly of clinical rotations in other specialties and the family medicine-specific training. We conducted this study to investigate how family medicine residents evaluated their training program that include family-oriented medicine, clinical preventive medicine, behavioral science and research in primary care. METHODS: In 2009, third-year residents of 129 training hospitals in Korea were surveyed to investigate the current state and their expectation of the residency program. The contents of questionnaires included training periods, conferences, procedures, interview techniques, outpatient and inpatient consultations, and written thesis. RESULTS: Total 133 out of 142 residents (93.7%) responded that 3 years of training is ideal or pertinent. Residents responded that the types of conference that they need most are journal review (81%), staff lecture (73.2%), and clinical topic review (73.2%), in that order. Procedures and interview techniques that the residents want to learn most were gastroscopy (72.5%), abdominal ultrasonography (65.2%), and pain management (46.4%). Hospitals where family medicine residents do not see hospitalized patients or patients in the outpatient clinic were 7.9% and 6.5%, respectively, whereas hospitals that maintain continuous family medicine outpatient clinics were only 40.8%. Education in outpatient clinic and articlewriting seminars was done less frequently in the secondary hospitals than in the tertiary hospitals. CONCLUSION: Evaluation and quality improvement of family medicine training program as well as specialty rotations should be considered in order to foster better family physicians. The efforts have to be made to minimize the difference in quality of each family medicine residency program.
Ambulatory Care Facilities ; Behavioral Sciences ; Clinical Medicine ; Congresses as Topic ; Family Practice ; Gastroscopy ; Humans ; Inpatients ; Internship and Residency ; Korea ; Outpatients ; Pain Management ; Physicians, Family ; Preventive Medicine ; Quality Improvement ; Referral and Consultation

BACKGROUND: Hemoglobin A1c (HbA1c) was adopted as a new standard criterion for diagnosing diabetes. We investigated the diagnostic utility of HbA1c by comparing the 2003 American Diabetes Association (ADA) diagnostic criteria of diabetes with HbA1c of 6.5%. Furthermore, the cut-off value for HbA1c was investigated using receiver operating characteristic curves. METHODS: This study included 224 subjects without a history of diabetes that had a fasting plasma glucose level of above 100 mg/dL. The subjects had undergone a 75 g oral glucose tolerance test, and diabetes was defined as according to 2003 ADA criteria. RESULTS: The prevalence of newly diagnosed diabetes was 58.2% by the 2003 ADA criteria, and 47.8% by HbA1c of 6.5%, which underestimated the prevalence of diabetes. Compared with the 2003 ADA criteria, the sensitivity and specificity of HbA1c of 6.5% were 73.5% and 89.1%, respectively. The kappa index of agreement between 2003 ADA and HbA1c criteria was 0.60. The cut-off point of HbA1c for diagnosing diabetes was 6.45% (sensitivity, 73.3%; specificity, 88.2%; area under the curve, 0.85). HbA1c was significantly associated with fasting glucose (r = 0.82, P < 0.01), postprandial glucose (r = 0.78, P < 0.01), and homeostasis model assessment of insulin resistance (r = 0.16, P < 0.05). CONCLUSION: For high risk patients whose fasting glucose was more than 100 mg/dL, HbA1c criterion underestimated the prevalence of newly diagnosed diabetes compared to the 2003 ADA criteria, and showed moderate agreement. The cut-off value for HbA1c was 6.45%, which was similar to the recommended diagnostic criterion of HbA1c by the 2009 ADA.
Fasting ; Glucose ; Glucose Tolerance Test ; Hemoglobin A, Glycosylated ; Hemoglobins ; Homeostasis ; Humans ; Insulin Resistance ; Plasma ; Prevalence ; ROC Curve ; Sensitivity and Specificity

Ultraviolet (UV) irradiation is an environmental factor that causes skin aging, and is also a major factor leading to cumulative alterations of skin structure, function and appearance. To investigate the effects of Selenium (Sel) on UV-induced skin aging, hairless mice were treated for 4 weeks with UV irradiation and topical application of Sel. Then, the effects of Sel were measured in the skin of these mice via histological analysis and Western blotting. According to the results of wrinkle formation analysis, the topical application of Sel induced a reduction in wrinkling formation in the damaged skin of the UV-irradiated mice. Additionally, our histological analysis demonstrated that the skin thickness in the Sel-treated group was less than in the UV-irradiated group. Furthermore, in an effort to investigate the mechanisms underlying the effects of Sel, the expression levels of matrix-metalloproteinase (MMP) and MAPK protein were assessed in both groups. The application of Sel induced a reduction in MMP-1 expression levels to the levels observed in the non-irradiated group. However, the expression level of MMP-9 was increased slightly in the Sel application group as compared with the vehicle application group. Additionally, the levels of ERK phosphorylation were increased by the application of Sel, but the levels of JNK and p38 were not altered by Sel treatment. These results suggest the possibility that Sel should be considered as a skin aging-protective and therapeutic drug candidate, which functions via the regulation of MMP expression levels.
Animals ; Blotting, Western ; Mice ; Mice, Hairless ; Phosphorylation ; Selenium ; Skin ; Skin Aging

Atopic dermatitis is an well-known skin disease showing inflammatory, chronically relapsing, non-contagious and pruritic symptoms. The aims of this study were to investigate the effects of Liriope platyphylla (LP) on atopic dermatitis of NC/Nga mice. To achieve this, NC/Nga mice were treated with four different conditions including vehicle, phthalic anhydride (PA), PA+5% LP and PA+10% LP, and the changes of immune-related factors were detected after 2 weeks. The pathological phenotypes of atopic dermatitis such as erythema, ear thickness, edema, scab and discharge were significantly decreased in PA+10% LP cotreated groups compare to PA treated group. Also, the weight of lymph node and thymus in immune organs were gradually decreased in LP treated groups, while the weight of spleen was slightly increased in same group. Furthermore, toluidine blue staining analysis, a method used to specifically identify the mast cell, showed that the decrease of master cell infiltration into the dermis were statistically observed in PA+5% LP and PA+10% LP5% cotreated groups. Especially, the decrease of IgE concentration was detected only PA+10% LP cotreated group, although this level was maintained in PA+5% LP cotreated group. Therefore, these results suggested that the water extracts of LP may contribute the relieve of atopic dermatitis symptoms and be considered as an excellent candidate for a atopic dermatitis-therapeutic drug.
Animals ; Dermatitis, Atopic ; Dermis ; Ear ; Edema ; Erythema ; Immunoglobulin E ; Lymph Nodes ; Mast Cells ; Mice ; Phenotype ; Phthalic Anhydrides ; Skin Diseases ; Spleen ; Thymus Gland ; Tolonium Chloride ; Water