During the Middle East respiratory syndrome (MERS) outbreak in 2015, the Ministry of Health and Welfare (MOHW) of the Republic of Korea provided outbreak information targeting international visitors and foreign residents through multiple channels. The MOHW created a MERS portal website in Korean and English on 10 June 2015; in addition, the existing MOHW website provided English-language press releases beginning 28 May. A toll-free telephone hotline also started service in English on 12 June; it expanded to include 18 other foreign languages on 15 June. This report describes the usage of these multi-language communication channels during this MERS outbreak.

Suicide notes are essential for investigating the psychological state of suicide victims and establishing suicide prevention programs. Since only a few studies have attempted to identify the causes of suicidal behavior through suicide notes, it would be worth examining suicide notes. Quantitative research on suicide has offered a limited understanding of suicide. Results showed that the suicide victims had used the suicide note as a tool for their last communication. Further, in addition to neutral contents such as directions for funeral, the note often contained information about precipitating events that caused the suicidal ideation. Writing a suicide note seemed to help the victims consider concrete plans for suicide. This study proved that qualitative research on suicide notes would be helpful for researchers to understand suicide victims in depth, which cannot be achieved by quantitative methods alone. Based on these results, several suggestions for suicide prevention programs were discussed.
Qualitative Research ; Suicidal Ideation ; Suicide* ; Writing

The purpose of this study was to examine the effects of dietary caffeine supplementation on bone mineral density and bone mineral content in ovariectomized rats. Twenty eight female Sprague-Dawley rats (body weight 210 +/- 5 g) were divided into two groups, ovariectomy (OVX) and Sham groups, which were each randomly divided into two subgroups that were fed control and control supplemented with caffeine diets (caffeine 0.03% diets). All rats were fed on experimental diet and deionized water ad libitum for 6 weeks. Bone mineral density (BMD) and bone mineral content (BMC) were measured using PIXImus (GE Lunar Co, Wisconsin) in spine and femur. Serum alkaline phosphatase activity (ALP) and osteocalcin and urinary DPD crosslinks value were measured as markers of bone formation and resorption. The results of this study indicate that body weight gain and food intake were higher in OVX groups than in Sham groups regardless of diets. There were no differences weight gain between the control and caffeine groups in both OVX and Sham groups. Within the OVX groups, serum Ca concentration was lower in rats fed caffeine than in rats fed the control diet. Serum ALP, osteocalcin, urinary Ca, and phosphate were not different in each group. Spine BMD, spine BMD/weight, and spine BMC/weight, femur BMD/weight and femur BMC/weight of ovariectomy groups were significantly lower than Sham groups. Within the OVX group, there were no differences in spine BMD and BMC and femur BMD and BMC. These results indicate that no significant differences in spine and femur BMD were found due to 0.03% caffeine intakes in diet in OVX rats for 6 weeks. No negative effect of caffeine in 0.03% diet on bone mineral density were found in the present study. Further investigation of the relation between caffeine and bone mineral density are warranted.
Alkaline Phosphatase ; Animals ; Body Weight ; Bone Density ; Caffeine ; Diet ; Eating ; Female ; Femur ; Humans ; Osteocalcin ; Osteogenesis ; Ovariectomy ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Spine ; Water ; Weight Gain

Muir-Torre syndrome (MTS) is an autosomal dominant genodermatosis first described in 1967 by Muir and in 1968 by Torre. It is characterized by the presence of at least one sebaceous gland tumor and the presence of a low-grade internal malignancy. The sebaceous neoplasia are typically adenomas, sebaceomas/sebaceous epitheliomas, or carcinomas. Most common internal malignancy is colorectal adenocarcinoma, but also neoplasia of the uterus, ovary and kidney may occur. Recent studies about genetic defect revealed MTS was caused by germline mutations in DNA mismatch repair genes and microsatellite instability. We report a case of MTS, multiple sebaceous adenomas with colorectal cancer in a 67-year-old male.
Adenocarcinoma ; Adenoma ; Aged ; Carcinoma ; Colorectal Neoplasms ; DNA Mismatch Repair ; Female ; Germ-Line Mutation ; Humans ; Kidney ; Male ; Microsatellite Instability ; Muir-Torre Syndrome* ; Ovary ; Sebaceous Glands ; Uterus

PURPOSE: To evaluate the results of the treatment of locally advanced but resectable rectal cancers and to analyze prognostic factors, especially with the emphasis on the treatment time factor. MATERIALS AND METHODS: There were 71 patients with rectal cancer who had been treated by curative surgical procedure and postoperative radiotherapy from August 1989 to December 1993. The minimum follow up period was 24 months and the median follow-up was 35 months. Radiation therapy had been given by 6 MV linear accelerator by parallel opposing or four-box portals. Whole pelvis was treated up to 5040 cGy in most cases. Systemic chemotherapy had been given in 94% of the patients, mostly with 5-FU/ACNU regimen. Assessment for the overall and disease-free survival rates were done by life-table method and prognostic factors by Log-Rank tests. RESULTS: Five-year overall survival, disease-free survival were 58.8% and 57%, respectively. Two-year local control rate was 76.6%. Stage according to Modified Astler-Coller (MAC) system, over 4 positive lymph nodes, over 6weeks interval between definitive surgery and adjuvant radiotherapy and over 7 days of interruption during radiotherapy period were statistically significant, or borderline significant prognostic factors. CONCLUSION: The treatment results of patients with rectal cancers are comparable to those of other large institutes. The treatment results for the patients with bowel wall penetration and/or positive regional lymph nodes were still discouraging for their high local recurrence rate for the patients with MAC 'C' stage diseases and high distant metastases rate even for the patients with node-negative diseases. Maybe more effective regimen ofchemotherapy would be needed with proper route and schedule. To maximize postoperative adjuvant treatment, radiotherapy should be started at least within 6 weeks after surgery and preferably as soon as wound healing is completed. Interruption of treatment during radiotherapy course affects disease-free survival badly, especially if exceeds 7 days. So, the total treatment period from definitive surgery to the completion of radiotherapy should be kept as minimal as possiable.
Academies and Institutes ; Appointments and Schedules ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Particle Accelerators ; Pelvis ; Radiotherapy ; Radiotherapy, Adjuvant ; Rectal Neoplasms* ; Recurrence ; Time Factors ; Wound Healing

BACKGROUND: Red blood cell (RBC) transfusion is one of the major treatments for correcting anemia, but its use should be carefully considered because of adverse transfusion reactions and inappropriate usage. Therefore, individual health care facilities have self evaluated their use of transfusion in an attempt to decrease unnecessary procedures. In this study, we evaluated the differences in the minimum hemoglobin (Hb) trigger for RBC transfusion among clinical departments in Severance Hospital. METHODS: We analyzed the electronic medical records of RBC transfusion episodes that were conducted at a Hb level above 8 g/dL from July 2014 to September 2015. We classified these data by clinical department, and considered the overall medical conditions of the patients. The minimum Hb trigger level in this study was defined as the lowest Hb level within 24 hours prior to RBC transfusion. RESULTS: A total of 4,953 RBC transfusion episodes that were conducted at Hb levels above 8 g/dL were analyzed over that period. In general, the minimum Hb trigger level was higher in the operation group than the hemorrhage group. When compared among clinical departments, the department of orthopedic surgery, neurosurgery, rehabilitation medicine, and anesthesiology showed high levels of minimum Hb trigger equal to or greater than 10 g/dL. CONCLUSION: The minimum Hb trigger level differed among clinical departments, with the operation group showing a much higher level of minimum Hb trigger. We hope that these data will be practically applied to establish plans and strategies for managing the appropriateness of RBC transfusions in Korea. In addition, continuous evaluation and transfusion education for clinical departments should be performed.
Anemia ; Anesthesiology ; Delivery of Health Care ; Education ; Electronic Health Records ; Erythrocyte Transfusion* ; Erythrocytes* ; Hemorrhage ; Hope ; Humans ; Korea ; Neurosurgery ; Orthopedics ; Rehabilitation ; Transfusion Reaction ; Unnecessary Procedures

Cutaneous metastasis from lung cancer is less common than metastasis from other organs. However, lung cancer is the most common origin of cutaneous metastasis in men and the second most common in women. Recognition of cutaneous metastatic cancer is important because it can be the first sign of visceral cancer. Although skin metastasis can appear on any cutaneous surface, the most common site is the chest wall. The prognosis for patients having lung cancer with cutaneous metastasis is very poor because the disease is advanced, with the involvement of other sites such as the brain, liver, bone, and adrenal gland. Herein, we report a case of an 87-year-old male with an undifferentiated metastatic carcinoma of the scrotum originating from lung cancer which was found later than the cutaneous metastatic cancer.
Adrenal Glands ; Aged, 80 and over ; Brain ; Female ; Humans ; Liver ; Lung Neoplasms* ; Lung* ; Male ; Neoplasm Metastasis ; Prognosis ; Scrotum ; Skin ; Thoracic Wall

This study examines how acquired capability for suicide, negative urgency, and social support effectuate a suicide attempt. Sixty-three adults having visited an emergency room due to a suicide attempt were studied. The results can be summarized as follows. First, there were no significant sex differences in acquired capability for suicide, negative urgency, and social support. Second, the correlation among suicidal ideation, acquired capability for suicide, negative urgency, social support, and suicide attempts was examined. Results showed that suicide attempts were significantly and positively correlated with suicide ideation, acquired capability for suicide, and negative urgency. However, social support and suicide attempts did not significantly correlate. Third, results of hierarchical regression analysis indicated that acquired capability for suicide and negative urgency significantly predicted suicide attempts even when suicide ideation was controlled, but social support did not significantly explain attempts. In other words, study results imply that suicide attempts increase when acquired capability for suicide and negative urgency are high. Study results offer empirical data for understanding the intrinsic characteristics of individuals attempting suicide.

Objective: The current study aimed to investigate the differences in sleep reactivity and sleep effort differs among late night shift workers (LSWs) and non-late night shift workers (non-LSWs), and non-shift workers (non-SWs). Methods: In total, 6,023 participants (1,613 non-SWs, 3,339 LSWs, and 1,071 non-LSWs) were recruited. Non-SWs was defined as those who works at fixed schedules during standard daylight. LSWs was defined as who work late night hours (10 PM–6 AM), while non-LSWs was SWs who did not work during late night. All completed the Ford Insomnia Response to Stress Test (FIRST), the Glasgow Sleep Effort Scale (GSES), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Insomnia Severity Index (ISI), and the short-term Center for Epidemiologic Studies-Depression scale (CES-D) through online survey. Results: LSWs and non-LSWs reported higher FIRST, GSES scores than non-SWs. In addition, LSWs reported higher FIRST, GSES scores than non-LSWs. FIRST scores were correlated with CES-D, PSQI, ISI, and ESS for LSWs, non-LSWs, and non-SWs alike. GSES scores were also correlated with CES-D, PSQI, ISI, and ESS for LSWs, non-LSWs, and non-SWs alike. Conclusion SWs showed higher sleep reactivity and sleep effort than non-SWs. LSWs had higher sleep reactivity and sleep effort than non-LSWs, and these variables are associated with insomnia, daytime sleepiness, and depressive symptoms. Our findings suggests that late night schedule, may increase sleep reactivity and sleep effort, which are associated with sleep and mood disturbances.

BACKGROUND: Automated cellular analyzers are expected to improve the analytical performance in body fluid (BF) analysis. We evaluated the analytical performance of three automated cellular analyzers and established optimum reflex analysis guidelines. METHODS: A total of 542 BF samples (88 cerebrospinal fluid [CSF] samples and 454 non-CSF samples) were examined using manual counting and three automated cellular analyzers: UniCel DxH 800 (Beckman Coulter), XN-350 (Sysmex), and UF-5000 (Sysmex). Additionally, 2,779 BF analysis results were retrospectively reviewed. For malignant cell analysis, the receiver operating characteristic (ROC) curve was used, and the detection of high fluorescence-BF cells (HF-BFs) using the XN-350 analyzer was compared with cytology results. RESULTS: All three analyzers showed good agreement for total nucleated cell (TNC) and red blood cell (RBC) counts, except for the RBC count in CSF samples using the UniCel DxH 800. However, variable degrees of differences were observed during differential cell counting. For malignant cell analysis, the area under the curve was 0.63 for the XN-350 analyzer and 0.76 for manual counting. We established our own reflex analysis guidelines as follows: HF-BFs <0.7/100 white blood cells (WBCs) is the criterion for quick scans with 100× magnification microscopic examination as a rule-out cut-off, while HF-BFs >83.4/100 WBCs or eosinophils >3.8% are the criteria for mandatory double check confirmation with 1,000× magnification examination. CONCLUSIONS The three automated analyzers showed good analytical performances. Application of reflex analysis guidelines is recommended for eosinophils and HF-BFs, and manual confirmation is warranted.