General anesthesia and sleep have long been discussed in the neurobiological context owingto their commonalities, such as unconsciousness, immobility, non-responsiveness to externalstimuli, and lack of memory upon returning to consciousness. Sleep is regulated bycomplex interactions between wake-promoting and sleep-promoting neural circuits. Anestheticsexert their effects partly by inhibiting wake-promoting neurons or activating sleep-promotingneurons. Unconscious but arousable sedation is more related to sleep-wake circuitries,whereas unconscious and unarousable anesthesia is independent of them. Generalanesthesia is notable for its ability to decrease sleep propensity. Conversely, increasedsleep propensity due to insufficient sleep potentiates anesthetic effects. Taken together, it isplausible that sleep and anesthesia are closely related phenomena but not the same ones.Further investigations on the relationship between sleep and anesthesia are warranted.

In order to investigate the incidence, clinical and microbiologic characteristics of Clostridium difficile infection (CDI) in Korea, a prospective observational study was performed. From September 2008 through January 2010, all patients whose stool was tested for toxin assay A&B and/or C. difficile culture were studied for clinical characteristics. Toxin types of the isolates from stool were tested. The mean incidence of CDI per 100,000 patient-days was 71.6 by month (range, 52.5-114.0), and the ratio of CDI to antibiotic-associated diarrhea was 0.23. Among 200 CDI patients, 37.5% (75/200) was severe CDI based on severity score. Clinical outcome of 189 CDI was as followed; 25.9% (49/189) improved without treatment, 84.3% (118/140) achieved clinical cure and attributed mortality was 0.7% (1/140) with the treatment. Recurrence rate was 21.4% (30/140) and cure without recurrence was 66.4% (93/140). The most common type of toxin was toxin A-positive/toxin B-positive strain (77.5%), toxin A-negative/toxin B-positive strains or binary toxin-producing strains comprised 15.4% or 7.1%, respectively. In conclusion, the incidence of CDI in Korea is a little higher than other reports during the non-epidemic setting. We expect that the change of epidemiology and clinical severity in CDI can be evaluated based on these results.
Aged ; Bacterial Proteins/analysis ; Bacterial Toxins/analysis ; Clostridium Infections/*epidemiology/physiopathology ; Clostridium difficile/*isolation & purification/*pathogenicity ; Diarrhea/epidemiology/microbiology ; Enterocolitis, Pseudomembranous/*epidemiology/microbiology/pathology ; Enterotoxins/analysis ; Feces/microbiology ; Female ; Hospitals ; Humans ; Incidence ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Prospective Studies ; Recurrence ; Republic of Korea/epidemiology ; Treatment Outcome ; Vancomycin/therapeutic use

PURPOSE: The purpose of this study was to categorize adult's subjectivity of their attitudes towards life sustaining treatment, and thereby understand the differences among these life sustaining treatment types using Q methodology. METHODS: Q-methodology, which provides a method of analyzing the subjectivity of each item, was used. Thirty selected Q-statements received from 52 adults were classified into a shape of normal distribution using a 7 point scale. The collected data was analyzed using a QUANL pc program. RESULT: Four types of attitudes toward life sustaining treatment were identified. Type I is called one's autonomy type. Type II is called potentiality of resuscitation type. Type III is called DNR (Do not resuscitation) type. Type IV is calledone's effort type. CONCLUSION: The results of the study indicate that different approaches of life support care programs are recommended based on the four types of life sustaining treatment attitudes among Korean adults.
Adult ; *Attitude to Death ; Humans ; *Life Support Care/psychology ; Middle Aged ; Q-Sort ; Terminal Care/psychology ; Withholding Treatment

Although radiotherapy (RT) is used for the treatment of cancers, including liver cancer, radiation-induced liver disease (RILD) has emerged as a major limitation of RT. Radiation-induced toxicities in nontumorous liver tissues are associated with the development of numerous symptoms that may limit the course of therapy or have serious chronic side effects, including late fibrosis. Although the clinical characteristics of RILD patients have been relatively well described, the understanding of RILD pathogenesis has been hampered by a lack of reliable animal models for RILD. Despite efforts to develop suitable experimental animal models for RILD, current animal models rarely present hepatic veno-occlusive disease, the pathological hallmark of human RILD patients, resulting in highly variable results in RILD-related studies. Therefore, we introduce the concept and clinical characteristics of RILD and propose a feasible explanation for RILD pathogenesis. In addition, currently available animal models of RILD are reviewed, focusing on similarities with human RILD and clues to understanding the mechanisms of RILD progression. Based on these findings from RILD research, we present potential therapeutic strategies for RILD and prospects for future RILD studies. Therefore, this review helps broaden our understanding for developing effective treatment strategies for RILD.
Fibrosis ; Hepatic Veno-Occlusive Disease ; Humans ; Liver Diseases* ; Liver Neoplasms ; Liver* ; Models, Animal ; Radiotherapy

PURPOSE: To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS). MATERIALS AND METHODS: Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy. RESULTS: The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%). CONCLUSION: Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.
Academic Medical Centers ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Korea ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Treatment Outcome

OBJECTIVES: The extract of Hizikia fusiformis is known to exhibit anticancer, antiatopic and antioxidant activities. We aimed to investigate the extract of H. fusiformis on allergic rhinitis inflammation in a mouse model. METHODS: The 4-week-old BALB/c mice were randomly assigned into four groups: group A, control group (n=9); group B, allergic rhinitis group (n=10); group C (n=10) received 300 mg/kg of H. fusiformis during nasal challenging period; group D (n=10) received 600 mg/kg of H. fusiformis during general sensitization period and 300 mg/kg of H. fusiformis during nasal challenging period. Allergic inflammation was made with ovalbumin (OVA) and alum then challenged intranasally with OVA. H. fusiformis was intraperitoneally administered 3 hours before the OVA administration. Allergic symptom score and the levels of immunoglobulin G1 (IgG1), IgG2a, OVA-specific IgE antibodies, levels of cytokines in the nasal mucosa and in spleen cell culture supernatant, such as tumor necrosis factor alpha (TNF-α), interleukin 4 (IL-4), IL-5, IL-13, and IL-10 were assessed. The percentage of regulatory T cell was analyzed by flow cytometry. Eosinophilic infiltration and goblet cell hyperplasia were also evaluated. RESULTS: H. fusiformis administered groups C and D showed significant inhibitory effects on nasal symptoms, IL-13 mRNA expression and eosinophil infiltration/goblet cell hyperplasia in the nasal tissue; OVA-specific IgE production in serum (P<0.05). In group D, H. fusiformis treatment downregulated IL-4, IL-5, IL-13, TNF-α, and IL-10 cytokine expression in splenocyte culture as well as significantly decreased IgG2a, IgG1 levels in serum compared with group B (P<0.05). However, the expressions of IL-5, interferon-γ and forkhead box P3 mRNA did not change in groups C and D. CONCLUSION: H. fusiformis could induce antiallergic inflammation by suppressing the T-helper type 2 cytokine production (IL-13) locally and systemically, OVA-specific IgE formation, goblet cell hyperplasia, and eosinophilic infiltration in a mouse model of allergic rhinitis. Thus, H. fusiformis could be considered as a potential therapeutic agent in treating allergic rhinitis.
Animals ; Antibodies ; Cell Culture Techniques ; Cytokines ; Eosinophils ; Flow Cytometry ; Goblet Cells ; Hyperplasia ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Inflammation ; Interleukin-10 ; Interleukin-13 ; Interleukin-4 ; Interleukin-5 ; Mice ; Nasal Mucosa ; Ovalbumin ; Ovum ; Rhinitis, Allergic ; RNA, Messenger ; Spleen ; Th2 Cells ; Tumor Necrosis Factor-alpha

Unmet healthcare needs do not end with the phenomenon itself, but lead to possibilities of increased severity of illness. Missed opportunities for treatment at the right timing increase possibilities of complications, and affect prognosis of disease. To examine current status and trends of unmet needs in Korea, we used data from four sources: the Korea National Health and Nutrition Examination Survey (KNHNES, '2007–2016); the Community Health Survey (CHS '2008–2016); the Korea Health Panel Survey (KHP '2011–2014); and the Korean Welfare Panel Study (KOWEPS '2006–2016). The proportion of individual reporting unmet healthcare needs as of 2016 was 8.8% (KNHNES), 11.5% (CHS), and 12.8% (KHP, as of 2014). Annual percentage change which characterizes trend for the follow-up period was −9.9%, −3.1%, and −1.3%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost was 1.8% (KNHNES), 1.5% (CHS), and 3.0% (KHP). The proportion of households reporting unmet healthcare needs due to cost was 1.0% (KOWEPS). Annual percentage change was −10.0%, −15.2%, −5.4%, and −17.5%, respectively. Low income populations had more unmet healthcare needs than high income populations. Therefore, in order to improve unmet healthcare needs, it is necessary to focus on low income populations.
Delivery of Health Care ; Family Characteristics ; Follow-Up Studies ; Health Surveys ; Korea ; Nutrition Surveys ; Population Growth ; Poverty ; Prognosis

Contralateral axillary lymph node metastasis is a rare entity in breast cancer and is currently classified as a distant metastasis; however, recent studies have proposed aggressive curative treatment since this entity may manifest as a locoregional disease. Herein, we report a rare case of contralateral axillary lymph node metastasis that presented with imaging findings 22 months after the initial breast cancer diagnosis in a 67-year-old female. The patient underwent lymph node dissection of the axilla with adjuvant chemotherapy and radiotherapy. A follow-up examination 6 months after surgery showed no evidence of tumor recurrence or metastasis.

Angiosarcoma of the breast is a rare malignant sarcoma of endovascular origin that presents with various radiological findings. We encountered a case of angiosarcoma of the breast presenting as an irregular indistinct hyperechoic mass on ultrasonography, with a large single angiosarcoma of the spleen in a previously healthy 36-year-old female. Herein, we report the imaging and pathologic findings and review the literature.