OBJECTIVES: The purpose of this study was to investigate the neurocognitive and psycho-physiological effects of total sleep deprivation by using the objective and quantifiable methods of Vienna Test System (Reaction Unit, Cognitrone, Vigilance) and P300 event-related potential. METHODS: Thirty healthy medical students(22 men, 8 women) participated in this study. Subjects remained awake for 38 hours under continuous surveillance. In the morning and the evening of two consecutive study days, the Vienna tests and P300 were performed. RESULTS: In Vigilance test of the Vienna Test System, a significant functional impairment occurred as a result of total sleep deprivation(p<.001). In Reaction unit, reaction time significantly increased (p<.01). However, in Cognitrone, a functional improvement was revealed. The P300 latency was significantly prolonged(p<.001) and amplitudes decreased(p<.01) as a consequence of total sleep deprivation. Comparing the results of Vigilance and Reaction unit each taken in the morning and evening, the performance decrements were prominent in morning sessions. In Cognitrone, evening session result showed the improvemed performance. CONCLUSIONS: The cognitive impairment resulting from 38 hours of sleep deprivation are considerable in alertness and reaction time tests, but not in higher complex cognitive functions such as fine perceptual analyses, visual discrimination, and short term memory. Considering the results with P300 latency and amplitudes, it may be concluded that the P300 changes as a result of total sleep deprivation are due to the decrement in the alertness which prolongs reaction time. More deterioration of cognitive performance shown in the morning, could be explained by considering circadian rhythm.
Circadian Rhythm ; Discrimination (Psychology) ; Event-Related Potentials, P300 ; Humans ; Male ; Memory ; Reaction Time ; Sleep Deprivation*

No abstract available.
Nocardia Infections*

Purpose: This study aimed to describe the desperate situation where the clinician should make decisions to further manage patients having experienced adverse drug reaction (ADR) to lamotrigine that is indicated to not easily controlled neuropsychiatric diseases. Methods: A descriptive analysis was done by thoroughly reviewing medical records of patients who were reported to have ADR to lamotrigine in a regional drug-safety center between 2010 and 2018. Results: Eighty-four cases of lamotrigine-related ADRs occurred in 80 patients. Skin lesions were most commonly observed in 70 cases (83.3%) and 14 cases (16.7%) had severe ADRs. Sixty-three subjects (78.8%) discontinued lamotrigine, while 17 (21.3%) continued it.At the time of discontinuation, 30.0% were prescribed aromatic antiepileptic drugs. Among 4 subjects who were eventually prescribed lamotrigine again after a period of discontinuation, 3 (75.0%) experienced its recurrence. Among patients who had taken alternative medications, the incidence of ADRs was higher in those being prescribed aromatic antiepileptic drugs than in the others being prescribed other than aromatic antiepileptic drugs (P = 0.013). Regarding the control of underlying diseases, as many as 65 (86.7%) and 68 (90.7%) failed to reach maintaining the resolved state from 6 months and 12 months after the substitution, respectively. Conclusion Patients can be easily trapped between the recurrence of ADRs and the treatment failure to a certain drug like lamotrigine, in which we can hardly find a reasonable alternative to manage them.

OBJECTIVE: This study was conducted to assess the current status of experiential education, by analyzing pharmacy students' satisfaction and evaluation for practice sites and preceptors for 3 years from 2014 through 2016. METHODS: Students evaluated the practice sites and preceptors using a 5-point and a 4-point Likert scale, respectively. Analysis was performed based on the types of curriculums and practice sites. In addition, sub-analysis was conducted based on the types of health-system pharmacy and the community pharmacy. RESULTS: Total 203 students responded to the survey questionnaires. The 3-year average score of students' satisfaction with practice sites was 4.25. In the sub-analysis conducted based on the types of health-system pharmacy, the score was higher in the tertiary hospital pharmacies than that of the general hospital pharmacies (4.49 vs. 4.06, P<0.001). For community pharmacy, the difference in the score of the 3-year analysis was not significant, depending on the types (4.51 vs. 4.33, P=0.054). The average score of students' evaluation on the preceptors was 3.37 in the 3-year analysis. The score was significantly higher for the preceptors of tertiary hospital pharmacies than those of general hospital pharmacies (3.61 vs. 3.25, P<0.001). For community pharmacy, no significant differences were found, depending on the types of pharmacy (3.53 vs. 3.43, P=0.309). CONCLUSION: The students' satisfaction with practice sites and preceptors in pharmacy experiential education was high. However, it varied greatly depending on the types of educational institutions. Mutual effort between university and educational institutions is required, to narrow the gap in the degree of students' satisfaction.
Curriculum ; Education* ; Hospitals, General ; Humans ; Pharmacies ; Pharmacy* ; Students, Pharmacy ; Tertiary Care Centers

The recent prevalence of syphilis has known to be increased progressively throughout the world, since middle of 1950. In Korea, current trend of increased syphilic infection has became a major public health problem. The authors selected sero-positive patients, among the outpaients of department of dermatology, urology, OB & GY, and physical examination, and performed statistical analysis of this sero-positive patients. Results are as following; 1) Of the 2,007 patients taken physical examination, 30 patient(1.49%) were reactive to VDRL. 2) 0.71% of the total out patients of the dermatologic dcpartment were sero-positive. Annual ratio of the syphilitic patient were increased progressively. 3) Ratio of the syphilitic patients to the total outpatients of OB & GY department was 0.55% and somewhat increased since 1976. 4) In the age distribution, the third decade shared 51.8% of the total sero-positive patients 5) In the sexual ratio. male:female=l: l. 62 in the total sero-positive patients. (male:female=l: 1.06 in the dermatologic department.) 6) In the stage distribution, latent syphilis patients were 59.14% of the total syphilitic patients.
Age Distribution ; Dermatology ; Female ; Humans ; Korea ; Outpatients ; Physical Examination ; Prevalence ; Public Health ; Syphilis ; Syphilis, Latent ; Urology

Objective: This study aimed to compare the efficacy between no-touch (NT) radiofrequency ablation (RFA) and conventional RFA using twin internally cooled wet (TICW) electrodes in the bipolar mode for the treatment of small hepatocellular carcinomas (HCC). Materials and Methods: In this single-center, two-arm, parallel-group, prospective randomized controlled study, we performed a 1:1 random allocation of eligible patients with HCCs to receive NT-RFA or conventional RFA between October 2016 and September 2018. The primary endpoint was the cumulative local tumor progression (LTP) rate after RFA. Secondary endpoints included technical conversion rates of NT-RFA, intrahepatic distance recurrence, extrahepatic metastasis, technical parameters, technical efficacy, and rates of complications. Cumulative LTP rates were analyzed using Kaplan-Meier analysis and the Cox proportional hazard regression model. Considering conversion cases from NT-RFA to conventional RFA, intentionto-treat and as-treated analyses were performed. Results: Enrolled patients were randomly assigned to the NT-RFA group (37 patients with 38 HCCs) or the conventional RFA group (36 patients with 38 HCCs). Among the NT-RFA group patients, conversion to conventional RFA occurred in four patients (10.8%, 4/37). According to intention-to-treat analysis, both 1- and 3-year cumulative LTP rates were 5.6%, in the NT-RFA group, and they were 11.8% and 21.3%, respectively, in the conventional RFA group (p = 0.073, log-rank). In the as-treated analysis, LTP rates at 1 year and 3 years were 0% and 0%, respectively, in the NT-RFA group sand 15.6% and 24.5%, respectively, in the conventional RFA group (p = 0.004, log-rank). In as-treated analysis using multivariable Cox regression analysis, RFA type was the only significant predictive factor for LTP (hazard ratio = 0.061 with conventional RFA as the reference, 95% confidence interval = 0.000–0.497; p = 0.004). There were no significant differences in the procedure characteristics between the two groups. No procedure-related deaths or major complications were observed. Conclusion NT-RFA using TICW electrodes in bipolar mode demonstrated significantly lower cumulative LTP rates than conventional RFA for small HCCs, which warrants a larger study for further confirmation.

Dieulafoy lesion is an uncommon cause of gastrointestinal bleeding, reported to be only 2% of acute or chronic upper gastrointestinal bleeding episodes. Bleeding occurs from a small mucosal erosion involving an unusually large submucosal artery in an otherwise normal mucosa. It is associated with massive, life threatening hemorrhage and is difficult to diagnosis. In most cases the lesion is encountered in the proximal stomach, antrum, duodenum, colon and rectum. In particular, extragastric Dieulafoy lesion is an extremely rare source of intestinal bleeding. In Korea, no case of bleeding from a Dieulafoy lesion of the small intestine has been previously reported. We experienced one case of bleeding from a jejunal Dieulafoy lesion, which was confirmed by the pathologic examination of the resected specimen, and report here.
Adult ; Arteries/abnormalities* ; Case Report ; Female ; Gastric Mucosa/blood supply* ; Gastrointestinal Hemorrhage/etiology* ; Human ; Intestinal Mucosa/blood supply*

PURPOSE: To evaluate the usefulness of stereoscopic localization of nonpalpable breast lesions. MATERIALS AND METHODS: The authors retrospectively analyzed 60 cases of stereotactic localization performed for lesions whichwere mammographically visible but not palpable. Each case was reviewed for chief complaint, indication oflocalization on a mammograph, location of the lesion, pathological diagnosis, and complications during and afterthe procedure. RESULTS: Most patients(75%) had no specific complaint. Among the 60 cases, microcalcification,mass and combined lesions were found in 34(57%), 12(20%), and 14 cases(23%), respectively. The most commonlocation of the lesion was the upper outer quadrant(29 cases). A histopathologic report was available in 56 of 60cases. Among 43 benign cases(76.8%), fibrocystic disease was most common(38 cases, 67.9%), while among 13malignant cases, ductal carcinoma was most common(9 cases, 16.1%). In four of 56 cases(7.1%), failure to removethe target lesion was identified. Retrospective analysis suggests that movement of the patient during theprocedure is the most likely cause of failure. There were no major complications. CONCLUSION: Stereotacticlocalization is simple and accurate, and compared with the conventional method, requires less experience on thepart of the practitioner. Movement of the patient during the procedure may be the major cause of failure.
Breast* ; Carcinoma, Ductal ; Diagnosis ; Humans ; Retrospective Studies

No abstract available.
Encephalitis* ; Humans ; Neurologic Manifestations ; Sweet Syndrome*

Clear cell renal cell carcinoma (ccRCC) is a disease with a wide variety of clinical progressions such as the rate of disease progression or the degree of metastasis. About 30% of ccRCC patients suffer from metastatic diseases, and about 30% develop metastasis after diagnosis. In the case of metastatic RCC, early prediction of the disease is important because of the poor prognosis, but ccRCC-specific molecular markers for clinical use are not available yet. As an alternative, liquid biopsy, which can find molecules released from tumor tissues in circulating blood and obtain information on metastatic dissemination and recurrence of ccRCC, is emerging. In this article, we will introduce molecules such as cell free DNA, cell free RNA, protein, and exosomes available as circulating biomarkers for liquid biopsy. We will also introduce some promising technologies that can compensate for the limitations of liquid biopsy.