OBJECTIVES: Considering large diversity of clinical presentation of schizophrenia, it is important to identify valid clinical subtypes or dimensions that might have homogeneous biological underpinning. The current study aimed to explore lifetime symptom-based dimensional phenotypes in patients with chronic schizophrenia, and to investigate their correlation with cognitive functions and other clinical characteristics. METHODS: Lifetime-based symptoms and additional clinical variables were measured using the Diagnostic Interview for Genetic Studies and the Schedule for the Deficit Syndrome in 315 clinically stable patients with chronic schizophrenia. Through principal components factor analysis, eight dimensional phenotypes were obtained. Comprehensive neuropsychological tests were administered for 103 out of 315 patients, and domain scores were calculated for cognitive domains defined in the MATRICS consensus battery. RESULTS: 'Non-paranoid delusion factor' including delusions of grandiose or religious nature, showed significant negative correlation with processing speed, working memory, attention/vigilance, and general cognitive ability, and positive correlation with intra-individual variability. 'Negative symptom factor' showed significant negative correlation only with general cognitive ability. Those two factors were also negatively correlated with function levels measured by Global Assessment Scale (GAS), and associated with poor treatment responses. CONCLUSION: Symptom-based dimensional phenotypes of schizophrenia measured on a lifetime basis showed discriminative correlation with cognitive function domains, global functioning level, and overall treatment responses, indicating their possibility as valid phenotype axes of schizophrenia having homogeneous biologic basis.
Appointments and Schedules ; Cognition ; Consensus ; Delusions ; Humans ; Memory, Short-Term ; Neuropsychological Tests ; Phenotype ; Schizophrenia*

Purpose: This study was conducted to investigate the mediating effects of mindfulness and growth mindset on the relationship between occupational stress and happiness among clinical nurses. Methods: The participants were 220 clinical nurses working in two hospitals in D city. Self-report questionnaires were used to collect the data, which were analyzed using t-test, one-way ANOVA, Pearson’s correlation coefficients, hierarchical multiple regression, and Sobel test. Results: Occupational stress had significant negative correlations with happiness, mindfulness, and growth mindset. On the other hand, mindfulness and growth mindset had significant positive correlations with happiness. Meanwhile, partial mediating effects of mindfulness and growth mindset were found on the relationship between occupational stress and happiness. Conclusion Mindfulness and growth mindset can play an important role in buffering the negative influence of occupational stress on the happiness of clinical nurses. Therefore, interventions that ease occupational stress and encourage mindfulness and growth mindset are recommended to increase happiness among clinical nurses.

Purpose: This study was conducted to investigate the mediating effects of mindfulness and growth mindset on the relationship between occupational stress and happiness among clinical nurses. Methods: The participants were 220 clinical nurses working in two hospitals in D city. Self-report questionnaires were used to collect the data, which were analyzed using t-test, one-way ANOVA, Pearson’s correlation coefficients, hierarchical multiple regression, and Sobel test. Results: Occupational stress had significant negative correlations with happiness, mindfulness, and growth mindset. On the other hand, mindfulness and growth mindset had significant positive correlations with happiness. Meanwhile, partial mediating effects of mindfulness and growth mindset were found on the relationship between occupational stress and happiness. Conclusion Mindfulness and growth mindset can play an important role in buffering the negative influence of occupational stress on the happiness of clinical nurses. Therefore, interventions that ease occupational stress and encourage mindfulness and growth mindset are recommended to increase happiness among clinical nurses.

A method for simultaneously identifying antioxidative compounds was developed using time-based LC-MS coupled with DPPH assay regardless of the time consuming process. The methanolic extract of Polygonum aviculare (Polygonaceae) showed significant DPPH radical scavenging activity. Time-based DPPH assay for simultaneous identification of active compounds from the extracts of P. aviculare was used. Major peaks of ethyl acetate fraction of P. aviculare showed high DPPH radical scavenging activity. A simple phenolic compound (1) and six flavonoids (2-7) were isolated from the ethyl acetate fraction of P. aviculare by silica gel and sephadex LH-20 column chromatography. The structures of seven compounds were determined to be protocatechuic acid (1), catechin (2), myricitrin (3), epicatechin-3-O-gallate (4), avicularin (5), quercitrin (6), and juglanin (7) based on the analysis of the 1H-NMR, 13C-NMR and ESI-MS data. All compounds exhibited significant antioxidant activity on DPPH assay and active compounds were well correlated with predicted one.
Catechin ; Chromatography ; Flavonoids ; Methanol ; Phenol ; Polygonum* ; Silica Gel

The ethyl acetate fractions prepared from the leaves of Thuja orientalis significantly inhibited nitric oxide (NO) production in lipopolysaccharide-stimulated BV2 microglial cells. According to bioassay-coupled LC-QTOF MS/MS, the components near 22 and 25 mins in the mass chromatogram highly inhibited NO production and were expected to be labdane diterpenes, and the active components were characterized via further isolation. The results of the NO production inhibitory assay of the isolated compounds correlated well with the results of bioassay-coupled LC-QTOF MS/MS. Among the identified constituents, NO production inhibitory activities of 16-hydroxy-labda-8(17),13-diene-15,19-dioic acid butenolide (2) and 15-hydroxypinusolidic acid (3) were newly reported. Taken together, these results demonstrated that LC-QTOF MS/MS coupled with NO production inhibition assay was a powerful tool for accurately predicting new anti-inflammatory constituents in the extracts from natural products. Moreover, it provided a potential basis for broadening the application of bioassay-coupled LC-QTOF MS/MS in natural product research.

Purpose: The objective of this study was to identify the significance of 24-hour postreduction ultrasonography (US) in pediatric patients with intussusception. Methods: A total of 229 patients with intussusception who were treated with saline reduction at Severance Children’s Hospital between January 2014 and September 2020 were retrospectively reviewed. The 229 patients with successful saline reduction were divided into two groups: a recurrence at 24 hours group (R, n=41) and a non-recurrence group (NR, n=188). The full patient sample was divided into two groups: follow-up US (FU) or no followup US (NFU); the recurrence group was divided into follow-up (R-FU) and non-follow-up (R-NFU) subgroups, and stratified analyses were performed. Results: There were no significant differences in age, sex, laboratory findings, symptoms, and sonographic findings between the NR and R groups. In the R group, 24 patients underwent follow-up US, and 17 patients did not. Specific sonographic findings were statistically significant in the R-FU group compared to the R-NFU group (p=0.002). The R-FU group had fewer admissions (p=0.012) and longer mean hospitalization times (p<0.001) than the R-NFU group. The NFU group had a 12.2% recurrence rate, while the R-FU group recurrence rate was 25.8% (p=0.0099), suggesting that the omission of some recurrent events and follow-up US was a significant variable in the recurrence of intussusception. The median time to recurrence was 21 hours which supports the 24-hour follow-up protocol. Conclusion Twenty-four-hour follow-up US was shown to be valuable for detecting early recurrence of intussusception.

Purpose: Liver transplantation (LT) is the only curative treatment for acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). In high-volume therapeutic plasma exchange (HV-TPE), extracorporeal liver support filters accumulate toxins and improve the coagulation factor by replacing them. In this study, we aimed to evaluate the effectiveness of HV-TPE in pediatric patients with ALF and ACLF. Methods: We reviewed the records of children waiting for LT at Severance Hospital who underwent HV-TPE between 2017 and 2021. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), total and direct bilirubin (TB and DB), gamma-glutamyl transferase (GGT), ammonia, and coagulation parameter-international normalized ratio (INR) were all measured before and after HV-TPE to analyze the liver function. The statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0 (IBM Co., Armonk, NY, USA). Results: Nine patients underwent HV-TPE with standard medical therapy while waiting for LT. One had neonatal hemochromatosis, four had biliary atresia, and the other four had ALF of unknown etiology. Significant decreases in AST, ALT, TB, DB, GGT, and INR were noted after performing HV-TPE (930.38–331.75 IU/L, 282.62–63.00 IU/L, 11.75–5.59 mg/dL, 8.10– 3.66 mg/dL, 205.62–51.75 IU/L, and 3.57–1.50, respectively, p<0.05). All patients underwent LT, and two expired due to acute complications. Conclusion HV-TPE could remove accumulated toxins and improve coagulation. Therefore, we conclude that HV-TPE can be regarded as a representative bridging therapy before LT.

Pyoderma gangrenosum (PG) is a rare, non-infectious, neutrophilic dermatosis characterized by painful ulcers with indistinct borders and peripheral erythema. The diagnosis of PG requires the exclusion of other causes of similar appearing skin manifestations, including vasculitis and infections. The pathogenesis of PG is not clear; however, dysregulation of the immune system has been suggested in previous studies. More than half of the PG patients have underlying diseases; the most common being inflammatory bowel disease (IBD). The progression of PG in IBD patients is seen after the onset of IBD, usually during its exacerbation. On the other hand, PG may follow a course independent of the intestinal disease. We present a case of an 18-year-old young male with PG that presented before being diagnosed with ulcerative colitis as an associated condition. He had a painful ulcerative lesion on his right shin with no previous gastrointestinal symptoms. This case suggests that investigating for underlying disorders is essential in PG patients despite the lack of symptoms other than the skin lesions.

OBJECTIVES: Intra-individual variability of cognitive performance across different tests or domains has been reported as an important index of cognitive function. The aim of the current study is to examine the intra-individual variability across different cognitive domains and tests in patients with schizophrenia, their unaffected siblings, and normal controls. We also compared the variability among three patient sub-groups divided according to the duration of illness. METHODS: Comprehensive neurocognitive tests were administered in order to stabilize patients with schizophrenia (n=129), healthy siblings (n=38) of the patients, and normal controls (n=110). Intra-individual variability was computed from the variance of the scores of six cognitive domains of the Measurement and Treatment Research to Improve Cognition in Schizophrenia consensus battery. We examined intra-individual variability across six factor-based cognitive scores and individual test scores of each cognitive domain. RESULTS: Compared to the normal control and sibling groups, patients showed significantly increased intra-individual variability across six cognitive domains and individual cognitive tests of each domain. Compared to the normal control, siblings showed significantly increased intra-individual variability only across individual tests of the processing of speed domain. Among patient sub-groups, those with the longest duration of illness (> or =11 years) showed significantly higher intra- individual variability across six cognitive domains and across individual tests of the processing of speed domain compared to the other two groups. CONCLUSION: This study identified cognitive dissonances across six cognitive domain schizophrenia patients. These cognitive characteristics were not observed in the sibling groups and seemed to progress during the course of illness.
Cognition ; Cognitive Dissonance ; Consensus ; Humans ; Neuropsychological Tests* ; Schizophrenia* ; Siblings*

OBJECTIVE: This study was conducted to evaluate the concordance between the underlying causes of death (UCOD) on the death certificates written by three emergency physicians (EPs). We investigated errors on the death certificates committed by each EP.METHODS: This study included 106 patients issued a death certificate in the emergency department of an academic hospital. Three EPs reviewed the medical records retrospectively and completed 106 death certificates independently. The selection of the UCOD on the death certificates by each EP (EP-UCOD) was based on the general principle or selection rules. The gold standard UCOD (GS-UCOD) was determined for each patient by unanimous consent between three EPs. We also compared between the EP-UCOD and the GS-UCOD. In addition, we compared between UCODs of three EPs. The errors on the death certificates were investigated by each EP.RESULTS: The rates of concordance between EP-UCOD and the GS-UCOD were 86%, 81%, and 67% for EP-A, EP-B, and EP-C, respectively. The concordance rates between EP-A and EP-B were the highest overall percent agreement (0.783), and those between EP-A and EP-C were the lowest overall percent agreement (0.651). Although each EP had differences in the errors they committed, none of them listed the mode of dying as UCOD.CONCLUSION: This study confirmed that each EP wrote death certificates indicating different causes of death for the same decedents; however, the three EPs made fewer errors on the patients’ death certificates compared with those reported in previous studies.
Cause of Death ; Death Certificates ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Medical Records ; Mortality ; Retrospective Studies