As the placebo effect is inevitable in almost all types of treatment implemented in the context of the doctor-patient relationship, it would be a wise strategy to try to enhance the treatment effect by understanding its mechanism and applying it clinically. However, for various reasons there is resistance to therapeutical application of placebos. The main reason for this resistance comes from the confusion about the concept of the placebo, and it is necessary to differentiate the placebo response and the placebo effect and understand them clearly. Meta-analytical reviews of clinical studies showed that the placebo effect accounts for part of clinical effect of drugs. Authors reviewed meta-analytic studies dealing with the placebo effect on depression, sleep disorders, dementia, anxiety and addiction. In addition, we discussed the current state of placebo use and also the way to promote the placebo effect.
Antidepressive Agents ; Anxiety ; Dementia ; Depression ; Effect Modifier, Epidemiologic ; Placebo Effect ; Placebos* ; Sleep Wake Disorders

BACKGROUND AND OBJECTIVES: Although Ling 6 sounds are often used in the rehabilitation process, its acoustic features have not been fully analyzed and represented in cortical responses. Current study was aimed to analyze acoustic features according to gender and emotional statuses of core vowels of Ling 6 sounds, /u/, /a/, and /i/. Cortical auditory evoked potentials (CAEPs) were also observed in those vowels. SUBJECTS AND METHODS: Vowel sounds /u/, /a/, and /i/ out of Ling 6 sounds representing low, middle and high frequencies were recorded from normal 20 young adults. The participants watched relevant videos for 4-5 minutes in order for them to sympathize emotions with anger (A), happiness (H), and sadness (S) before producing vowels. And without any emotional salience, neutrally production was performed. The recording was extracted for 500 ms to select pure vowel portion of production. For analysis of CAEP, the latencies and amplitudes of P1, N1, P2, N2, N1-P2 were analyzed. RESULTS: Intensities of /u/, /a/, and /i/ were 61.47, 63.38, and 60.55 dB. The intensities of neutral (N), H, A, S were 60.60, 65.43, 64.21, and 55.75 dB for vowel /u/, vowel /a/ were 61.80, 68.98, 66.50, and 56.23 dB, and vowel /i/ were 59.34, 64.90, 61.90, and 56.05 dB. The statistical significances for vowel and emotion were found but not for gender. The fundamental frequency (F0) of vowels for N, A, H, and S were 168.04, 174.93, 182.72, and 149.76 Hz and the first formant were 743.75, 815.59, 823.32, and 667.62 Hz. The statistical significance of F0 was found by vowel, emotion, and gender. The latencies and amplitudes of CAEP components did not show any statistical significance according to vowel. CONCLUSIONS: Ling 6 sounds should be produced consistently in the rehabilitation process for considering their difference of intensities and frequencies according to speaker’s emotions and gender. The vowels seemed to be interpreted as tonal stimuli for CAEP components of this study with similar acoustic features among them. Careful selection of materials is necessary to observe meaningful conclusion of CAEP measurement with vowel stimuli.
Acoustics ; Anger ; Evoked Potentials, Auditory ; Happiness ; Humans ; Rehabilitation ; Young Adult

BACKGROUND: Diagnostic rate of Yersinia pseudotuberculosis infection by stool culture is low and slide agglutination (SA) method in serum has diagnostic problem due to high false positive rate and cross reaction with other febrile diseases. Therefore we tried to develop first stage whole cell Enzyme-linked immunosorbent assay (ELISA) test against Y. pseudotuberculosis antigen using Korean strains of Y. pseudotuberculosis. METHODS: Korean strains of Y. pseudotuberculosis (serotype:4b and 15) were cultured and cell wall was destroyed by sonifier and used as antigen. Microplate wells were coated with antigen and sera of three group (patient group, control group and adult group) were added and incubated at 37degreesC. Peroxidase conjugated rabbit antihuman IgG and goat antihuman IgM were added and substrate (3,3',5,5'-tetramethylbenzidine) adding was followed. Optical density was measured by spectrophotometer at 450 nm. RESULTS: Patient group (n=22) who has more than 1:80 titer in SA method showed 27.3% positivity in IgG antibody and 63.6% positivity in IgM antibody in noncompetitive sandwich method of ELISA test. Adult group (n=50) showed 26.0% positivity in IgG antibody. Positivity rate of antibody in ELISA test was not correlated with agglutination titer in SA method but both antibodies were positive in 3 cases which have agglutination titer above 1:1280. CONCLUSIONS: Whole cell ELISA test was tried by Y. pseudotuberculosis antigens using serotypes which were isolated in Korea. Positivity rate of both IgG and IgM antibodies by ELISA test was not correlated with agglutination titer of SA method.
Adult ; Agglutination ; Antibodies ; Cell Wall ; Control Groups ; Cross Reactions ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Goats ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Korea ; Peroxidase ; Yersinia pseudotuberculosis* ; Yersinia*

BACKGROUND: We aimed to investigate the role of the physician in practice and the factors that influence the success rate of smoking cessation. METHODS: This study retrospectively analyzed 126 adult smokers who had visited the outpatient department of pulmonology, and received motivational interviewing with or without supplement drugs. The findings include continuous smoking abstinence rate, which was evaluated at 6, 12 and 24 weeks, and the factors associated with continuous abstinence for 6 months or longer. RESULTS: The patients with only motivational interviewing accounted for 57.9%, while the nicotine patch therapy was applied to 30.2%; and varenicline was prescribed to 11.9%. The smoking cessation success rates of at 6, 12, and 24 weeks were 55.6%, 47.6%, and 33.3%, respectively. However, even in the failure group at six months, tobacco consumption was decreased under 10 cigarettes per day in 42.1% (53/126). In multivariate logistic regression analysis, degree of Fagerstom Test for Nicotine Dependence (p=0.034; odds ratio, 3.607; 95% confidence interval [CI], 1.102-1.807), the absence of smoking-related lung disease (p=0.008; odds ratio, 4.693; 95% CI, 1.497-14.707), and education level (p=0.001; odds ratio, 181.420; 95% CI, 8.414-3,911.502) were the predictors of successful smoking cessation. CONCLUSION: An improved continuous smoking abstinence rate can be obtained by motivational interviewing, regardless of the association with pharmacotherapy.
Adult ; Drug Therapy ; Education ; Humans ; Logistic Models ; Lung Diseases ; Motivational Interviewing* ; Odds Ratio ; Outpatients ; Pulmonary Medicine ; Retrospective Studies ; Smoke ; Smoking ; Smoking Cessation* ; Tobacco Products ; Tobacco Use ; Tobacco Use Cessation Products ; Tobacco Use Disorder ; Varenicline

PURPOSE: Mortality in emergency department sepsis (MEDS), sepsis-related organ failure assessment (SOFA), multiple organ dysfunction score (MODS), and serum lactate levels have shown their efficacy in the early detection of patients with a bad prognosis. However, those studies did not consider differences in treatment protocols and could not rule out the interference of these differences in treatment modalities. Hence, we aimed to assess the performance of MEDS, MODS, SOFA, and serum lactate levels for predicting a bad prognosis in patients scheduled for identical, standardized treatment protocols, EGDT. METHODS: Medical records of patients who visited a tertiary level teaching hospital and were enrolled in an EGDT program between October 2009 and May 2010, were retrospectively reviewed. MEDS, SOFA, and MODS scores were calculated and recorded along with serum lactate levels. Receiver operating characteristics (ROC) curves of those predictors of mortality were plotted, Bivariate correlation analyses with overall lengths of admission and ICU lengths of stay were done for surviving patients. RESULTS: None of the diagnostic methods (serum lactate level, MEDS, SOFA, MODS) showed a significant difference on ROC analysis (p=0.819, 0.506, 0.811, 0.873, respectively). Bivariate correlation analyses of MEDS, SOFA, MODS and overall lengths of admission showed significant results (p=0.048, 0.018, and 0.003, respectively. Pearson correlation coefficients were, 0.263, 0.312, and 0.381). Only MEDS showed a significant correlation with intensive care unit (ICU) length of stay (p=0.032, Pearson correlation coefficient = 0.332). CONCLUSION: Neither MEDS, SOFA, MODS, nor serum lactate level can predict mortality in EGDT-enrolled patients. MEDS may be correlated with ICU length of stay.
Clinical Protocols ; Emergencies ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Medical Records ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Retrospective Studies ; ROC Curve ; Sepsis ; Severity of Illness Index ; Treatment Outcome

OBJECTIVE: The aim of this study was to examine 1) public knowledge and perceptions about attention-deficit hyperactivity disorder (ADHD) and 2) factors influencing the public's decisions to adhere to ADHD pharmacotherapy. METHODS: In this study, 396 participants responded to the internet survey regarding their experiences, beliefs and treatment preferences about ADHD. RESULTS: 252 respondents (63.6%) were reluctant to pharmacological treatment of ADHD. The respondents chose the functional impairment of the brain as the main cause of ADHD were favorable to pharmacological treatment and scored significantly high on the ADHD Knowledge Questionnaire. On the other hand, the respondents who regarded ADHD as an overly active personality rather than a disease were skeptical to pharmacotherapy and scored significantly low. The respondents who were acquainted with someone who had been diagnosed with ADHD perceived themselves relatively well informed about ADHD. However, the subjective perception of the degree of knowledge of ADHD was not correlated with the objective score of the ADHD Knowledge Questionnaire. CONCLUSION: The public is not well informed about ADHD and its treatments. Culturally appropriate psychoeducational strategies based on the media and the internet are needed. Providing biomedical conceptualization of ADHD to the public may aid with treatment decisions and promote adherence to pharmacological treatment.
Brain ; Drug Therapy ; Hand ; Internet ; Surveys and Questionnaires

Background: Right ventricular (RV) systolic dysfunction is an established prognostic factor in patients with severe tri‑ cuspid regurgitation (TR). However, accurate assessment of RV systolic function using conventional echocardiography remains challenging. We investigated the accuracy of strain measurement using speckle tracking echocardiography (STE) for evaluating RV systolic function in patients with severe TR. Methods: We included consecutive patients with severe TR who underwent echocardiography and cardiac magnetic resonance imaging (CMR) within 30 days between 2011 and 2023. Two-dimensional STE was used to measure RV free wall longitudinal strain (RVFWLS) and global longitudinal strain (RVGLS). These values were compared with the RV ejection fraction (RVEF) from CMR. RV systolic dysfunction was defined as a CMR-derived RVEF < 35%. Results: A total of 87 patients with severe TR were identified during the study period. Among echocardiographic RV strain measurements, RVFWLS was the best correlate of CMR-derived RVEF (r = –0.37, P < 0.001), followed by RVGLS (r = –0.27, P = 0.012). Receiver operating characteristic (ROC) curve analysis revealed that RVFWLS provided better dis‑ crimination of RV systolic dysfunction, yielding an area under the ROC curve (AUC) of 0.770 (95% confidence interval [CI], 0.696–0.800) than RV fractional area change (AUC, 0.615; 95% CI, 0.500–0.859). Conclusions In patients with severe TR, STE-derived RVFWLS showed the best correlation with RVEF on CMR and dis‑ played superior discrimination of RV systolic dysfunction compared with the RV fractional area change. This study suggests the potential usefulness of STE in assessing RV systolic function in this population.

Background: Right ventricular (RV) systolic dysfunction is an established prognostic factor in patients with severe tri‑ cuspid regurgitation (TR). However, accurate assessment of RV systolic function using conventional echocardiography remains challenging. We investigated the accuracy of strain measurement using speckle tracking echocardiography (STE) for evaluating RV systolic function in patients with severe TR. Methods: We included consecutive patients with severe TR who underwent echocardiography and cardiac magnetic resonance imaging (CMR) within 30 days between 2011 and 2023. Two-dimensional STE was used to measure RV free wall longitudinal strain (RVFWLS) and global longitudinal strain (RVGLS). These values were compared with the RV ejection fraction (RVEF) from CMR. RV systolic dysfunction was defined as a CMR-derived RVEF < 35%. Results: A total of 87 patients with severe TR were identified during the study period. Among echocardiographic RV strain measurements, RVFWLS was the best correlate of CMR-derived RVEF (r = –0.37, P < 0.001), followed by RVGLS (r = –0.27, P = 0.012). Receiver operating characteristic (ROC) curve analysis revealed that RVFWLS provided better dis‑ crimination of RV systolic dysfunction, yielding an area under the ROC curve (AUC) of 0.770 (95% confidence interval [CI], 0.696–0.800) than RV fractional area change (AUC, 0.615; 95% CI, 0.500–0.859). Conclusions In patients with severe TR, STE-derived RVFWLS showed the best correlation with RVEF on CMR and dis‑ played superior discrimination of RV systolic dysfunction compared with the RV fractional area change. This study suggests the potential usefulness of STE in assessing RV systolic function in this population.

Background: Right ventricular (RV) systolic dysfunction is an established prognostic factor in patients with severe tri‑ cuspid regurgitation (TR). However, accurate assessment of RV systolic function using conventional echocardiography remains challenging. We investigated the accuracy of strain measurement using speckle tracking echocardiography (STE) for evaluating RV systolic function in patients with severe TR. Methods: We included consecutive patients with severe TR who underwent echocardiography and cardiac magnetic resonance imaging (CMR) within 30 days between 2011 and 2023. Two-dimensional STE was used to measure RV free wall longitudinal strain (RVFWLS) and global longitudinal strain (RVGLS). These values were compared with the RV ejection fraction (RVEF) from CMR. RV systolic dysfunction was defined as a CMR-derived RVEF < 35%. Results: A total of 87 patients with severe TR were identified during the study period. Among echocardiographic RV strain measurements, RVFWLS was the best correlate of CMR-derived RVEF (r = –0.37, P < 0.001), followed by RVGLS (r = –0.27, P = 0.012). Receiver operating characteristic (ROC) curve analysis revealed that RVFWLS provided better dis‑ crimination of RV systolic dysfunction, yielding an area under the ROC curve (AUC) of 0.770 (95% confidence interval [CI], 0.696–0.800) than RV fractional area change (AUC, 0.615; 95% CI, 0.500–0.859). Conclusions In patients with severe TR, STE-derived RVFWLS showed the best correlation with RVEF on CMR and dis‑ played superior discrimination of RV systolic dysfunction compared with the RV fractional area change. This study suggests the potential usefulness of STE in assessing RV systolic function in this population.

Background: Right ventricular (RV) systolic dysfunction is an established prognostic factor in patients with severe tri‑ cuspid regurgitation (TR). However, accurate assessment of RV systolic function using conventional echocardiography remains challenging. We investigated the accuracy of strain measurement using speckle tracking echocardiography (STE) for evaluating RV systolic function in patients with severe TR. Methods: We included consecutive patients with severe TR who underwent echocardiography and cardiac magnetic resonance imaging (CMR) within 30 days between 2011 and 2023. Two-dimensional STE was used to measure RV free wall longitudinal strain (RVFWLS) and global longitudinal strain (RVGLS). These values were compared with the RV ejection fraction (RVEF) from CMR. RV systolic dysfunction was defined as a CMR-derived RVEF < 35%. Results: A total of 87 patients with severe TR were identified during the study period. Among echocardiographic RV strain measurements, RVFWLS was the best correlate of CMR-derived RVEF (r = –0.37, P < 0.001), followed by RVGLS (r = –0.27, P = 0.012). Receiver operating characteristic (ROC) curve analysis revealed that RVFWLS provided better dis‑ crimination of RV systolic dysfunction, yielding an area under the ROC curve (AUC) of 0.770 (95% confidence interval [CI], 0.696–0.800) than RV fractional area change (AUC, 0.615; 95% CI, 0.500–0.859). Conclusions In patients with severe TR, STE-derived RVFWLS showed the best correlation with RVEF on CMR and dis‑ played superior discrimination of RV systolic dysfunction compared with the RV fractional area change. This study suggests the potential usefulness of STE in assessing RV systolic function in this population.