The selection of allergen panel is very important to test for innumerable allergens throughout the Korea. However, the allergens studied are heterogeneous depending on the area the patient live and there is no methodological unification. Although, testing panel of allergens should be tailored according to the geographical areas, considering the relatively small Korean Peninsula, common inhalant allergens for test could be retrieved from the published data. Hence, this study is aimed to review the longitudinal variance of allergens in patients with allergic rhinitis live in several regional provinces of Korea, figure out the similarity and differences of sensitized allergens results derived from each study and finally make a guideline for physician in selecting the offending allergens to test. From the inception, studies which analyzing the offending allergens by either ImmunoCAP®, Multiple Allergen Simultaneous Test or Skin testing were reviewed and we found that the common sensitized allergens are house dust mites, pollen and mold plus 1–2 notable different allergens according to the specific regions. Especially, a total of 10±3 allergens adequately detected most of the sensitization of the major regions of Korea according to each age groups and special regional features. This study suggest that physicians should perform the screening of allergic rhinitis with minimally selected allergen in the light of age categories and special regional features. Standardization of allergens selection process would be predicted to have enormous benefits in establishing an insurance policy, giving sound scientific evidence and monitoring the antigenic variations of the Korean Peninsula.

OBJECTIVE: In recent years there has been an enormous increase of neuroscience research using the facial expressions of emotion. This has led to a need for ethnically specific facial expressions data, due to differences of facial emotion processing among different ethnicities. METHODS: Fifty professional actors were asked to pose with each of the following facial expressions in turn: happiness, sadness, fear, anger, disgust, surprise, and neutral. A total of 283 facial pictures of 40 actors were selected to be included in the validation study. Facial expression emotion identification was performed in a validation study by 104 healthy raters who provided emotion labeling, valence ratings, and arousal ratings. RESULTS: A total of 259 images of 37 actors were selected for inclusion in the Extended ChaeLee Korean Facial Expressions of Emotions tool, based on the analysis of results. In these images, the actors' mean age was 38+/-11.1 years (range 26-60 years), with 16 (43.2%) males and 21 (56.8%) females. The consistency varied by emotion type, showing the highest for happiness (95.5%) and the lowest for fear (49.0%). The mean scores for the valence ratings ranged from 4.0 (happiness) to 1.9 (sadness, anger, and disgust). The mean scores for the arousal ratings ranged from 3.7 (anger and fear) to 2.5 (neutral). CONCLUSION: We obtained facial expressions from individuals of Korean ethnicity and performed a study to validate them. Our results provide a tool for the affective neurosciences which could be used for the investigation of mechanisms of emotion processing in healthy individuals as well as in patients with various psychiatric disorders.
Anger ; Arousal ; Facial Expression ; Female ; Happiness ; Humans ; Male ; Neurosciences

OBJECTIVE: South Korea has an increasing aging population; thus, the management of depressive symptoms in elderly individuals is important. In this population, fewer social contacts might be a risk factor for depressive symptoms. We examined associations between the frequency of social contacts and depressive symptoms among elderly Koreans and factors associated with these symptoms. METHODS: Data from 62,845 individuals over 65 years of age enrolled in the 2015 Community Health Survey were used in this study. Logistic regression was performed to test the association between depressive symptoms and social contacts. RESULTS: Individuals who had contact with neighbors less than once a week were more likely to experience depressive symptoms [odds ratio (OR): 1.22, 95% confidence interval (CI): 1.10–1.35] compared to those who had contact more than once a week. Individuals who had frequent contact with neighbors and friends, neighbors and relatives, or all three groups were significantly less likely to experience depressive symptoms. CONCLUSION: The frequency of social contact with neighbors was the most powerful factor associated with elderly adults’ depressive symptoms among other social relationships. Additional senior welfare centers may facilitate the ability of elderly individuals in meeting neighbors, thereby reducing the risk of depressive symptoms.
Aged* ; Aging ; Depression* ; Friends ; Health Surveys ; Humans ; Korea ; Logistic Models ; Risk Factors

Background: Polypharmacy, the use of multiple drugs, is a growing concern in older adults. It has been reported that the prevalence of polypharmacy in elderly patients is higher in Korea than in other countries. The objective of this study was to investigate the prevalence and associated factors of polypharmacy in elderly outpatients who visited a Seoul Medical Center. Methods: We retrospectively reviewed medical records of 12,551 elderly patients aged ≥65 years who visited outpatient clinics in a public hospital in Seoul between January 1, 2018 and December 31, 2018. We defined “polypharmacy” as the use of ≥6 medications per person; “major polypharmacy,” ≥11 medications per person; and “excessive polypharmacy,” ≥21 medications per person. Multivariate logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to investigate the risk factors for polypharmacy. Results: Among the elderly outpatients studied, 40.7% had polypharmacy, 11.9% major polypharmacy, and 0.8% excessive polypharmacy. The lowerincome medical aid population is associated with polypharmacy (OR, 1.70; 95% CI, 1.47–1.97). Conclusion We observed a high prevalence of polypharmacy in elderly outpatients, especially the medical aid population, who visited a Korean public hospital. Nationwide vigorous efforts to assess and reduce the prevalence of polypharmacy are urgently required for the Korean older population.

OBJECTIVES: To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. METHODS: We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. RESULTS: The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. CONCLUSIONS: We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs.
Commerce ; Computer Systems ; Decision Support Systems, Clinical ; Delivery of Health Care* ; Electronic Health Records ; Information Services ; Medical Informatics ; Medical Order Entry Systems ; Privacy ; Soaps ; Social Control, Formal

PURPOSE: The purpose of this study was to evaluate the clinical characteristics and efficacy of prophylactic treatment of pediatric chronic daily headache (CDH). METHODS: A retrospective medical-record review of patients who underwent the prophylaxis after a diagnosis of CDH was performed. Response to treatment was assessed by the total number of headache days/month. More than 50% reduction of headache frequency was classified as responders. RESULTS: Eighty patients with the diagnosis of CDH were included in the study. CDH was more prevalent in girls than in boys. It was classified into chronic migraine (81.2%), chronic tension-type headache (15.0%), or new-onset persistent daily headache (3.7%). None of the patient fulfilled the diagnostic criteria of hemicrania continua. The mean age of the patients was 11.8+/-1.2 years. The mean number of monthly headache episodes before treatment was 25.5+/-4.4. After prophylactic treatment, headache episodes were reduced to 8.7+/-9.5 episodes per month. The responder rate of prophylactic treatment was 70.2% (55/80 patients) for either topiramate or flunarizine. CONCLUSION: In our study, the most common type of CDH was chronic migraine. All patients with CDH had frequent, long lasting migraine attacks. This study also suggests that prophylactic treatment is effective in the treatment of pediatric CDH.
Fructose ; Headache ; Headache Disorders ; Humans ; Migraine Disorders ; Retrospective Studies ; Tension-Type Headache

BACKGROUND AND PURPOSE: There are few studies that have investigated predictive factors related to migraine prophylaxis of which produced inconsistent results. The aim of this study was to identify factors that can predict the treatment response to topiramate prophylaxis in pediatric patients with migraine. METHODS: One hundred and thirteen patients who were older than 7 years and received topiramate for at least 3 months were recruited from the Seoul National University Bundang Hospital outpatient clinic from 2005 to 2014. A positive response was defined as a reduction of more than 50% in the number of migraine episodes after topiramate treatment. Proposed predictive factors such as migraine characteristics including severity and frequency were assessed, as were other data on sex, disease duration, associated symptoms, family history, and impairment of daily activities. RESULTS: Seventy patients (61.9%) responded to prophylactic treatment with topiramate. Patients who experienced significant impairment in daily activities showed significant benefit from the treatment (p=0.004). Sex, the severity, frequency, and duration of migraine episodes, disease duration, treatment duration, age at onset, and associated symptoms were not significantly related to a response to topiramate treatment. CONCLUSIONS: Migraine characteristics and associated symptoms were not significantly related to a response to topiramate treatment. However, patients with significant impairment in daily activities showed significant benefit from the treatment, and so prophylactic topiramate treatment should be strongly encouraged in this patient group.
Age of Onset ; Humans ; Migraine Disorders* ; Outpatient Clinics, Hospital ; Seoul

PURPOSE: AQP-1 (Aquaporin-1) and VEGF (vascular endothelial growth factor) are known to play an important role in ultrafiltration in peritoneal dialysis. The aim of this study was to evaluate the expression of AQP-1 and VEGF and VEGFR-1 (VEGF type 1 receptor) in peritoneums obtained from uremic non-dialyzed patients and peritoneal dialysis patients and to see if expression of these molecules are correlated with each other and with pathological findings in peritoneum. METHODS: Peritoneal expressions of AQP-1, VEGF and VEGFR-1 were examined by immunohistochemistry using specific antibody to each molecule. The degree of vascular proliferation and inflammation in peritoneal tissues were assessed semi-quantitatively by a single pathologist. RESULTS: AQP-1, VEGF and VEGFR-1 were mainly expressed in the vascular endothelial cells in the peritoneum. No significant difference in peritoneal expression of these molecules was found according to the clinical situations in which peritoneal tissues were obtained. The degree of expression of AQP-1 and VEGF were related to each other but not related to expression of VEGFR-1. The expressions of AQP-1 and VEGF were related to the vascular proliferation. The expression of AQP-1 was also related to inflammation. CONCLUSION: In end-stage renal disease patients before and after initiation of peritoneal dialysis, the peritoneal expressions of AQP-1 and VEGF were related to vascular proliferation. Inflammation might have some influence in expression of AQP-1.
Endothelial Cells ; Humans ; Immunohistochemistry ; Inflammation ; Kidney Failure, Chronic ; Peritoneal Dialysis ; Peritoneum ; Ultrafiltration ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factor Receptor-1

PURPOSE: The purpose of this study was to describe the characteristic electroencephalographic features in Rasmussen's encephalitis by stage. METHODS: Patients diagnosed with Rasmussen's encephalitis at Seoul National University Children's Hospital were retrospectively assessed. We analyzed the background activities and epileptiform discharges from electroencephalography (EEG) findings to identify the characteristic EEG features by stage. RESULTS: Seven patients were included in the study. The mean age of first seizure onset was 6.7 years, and the mean duration of the prodromal phase was 21.4 months. During disease course, background activities, such as slow waves, were more prominent and diffuse, and contralateral slow waves were observed. In most patients, focal epileptiform discharges were observed during all stages without change. CONCLUSION: As Rasmussen's encephalitis progresses, background abnormalities in the affected hemisphere increased, and contralateral slow waves occurred. However, characteristic EEG findings that were distinguishable at each stage were not observed.
Electroencephalography ; Encephalitis* ; Epilepsy ; Humans ; Retrospective Studies ; Seizures ; Seoul

PURPOSE: The purpose of this study was to evaluate the efficacy and tolerability of extended-release valproic acid once daily dosing in juvenile myoclonic epilepsy (JME). METHODS: Medical records of patients who received valproic acid monotherapy for the treatment of JME were retrospectively reviewed. Their clinical information regarding age, gender, seizure types, underlying neurologic status, dosing regimen, response to treatment, and adverse events related to valproic acid, were analyzed. Seizure control, compliance, and adverse events rates were compared between the group of once daily dosing and the group of twice daily dosing. RESULTS: Twenty one patients (11 boys and 10 girls) were included in the study. Twelve patients were taking valproic acid extended-release once daily and nine patients were taking twice a day. More than 50% decrease in myoclonic seizure was achieved in all the patients in both groups. Generalized tonic-clonic seizure was controlled in all the patients who were taking once daily while 3 patients (36%, 3/8 patients) in twice daily group had breakthrough generalized tonic clonic seizures during the 2 year period of treatment. However, there were no statistically significant differences in seizure control, compliance, and adverse event rates between the two groups. CONCLUSION: This study demonstrated that valproic acid extended-release once daily dosing was as effective and tolerable as twice daily in the treatment of JME. Once daily dosing of valproic acid would be convenient which improve patient compliance and consequently bring better outcome in treatment of JME.
Compliance ; Humans ; Medical Records ; Myoclonic Epilepsy, Juvenile* ; Patient Compliance ; Retrospective Studies ; Seizures ; Valproic Acid*